Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Diabet Med. 2017 Nov;34(11):1637-1645. doi: 10.1111/dme.13441. Epub 2017 Aug 21.
To investigate the relationship between increasing parity and diabetes in a large, population-based cohort, and to examine if this relationship is different among high-risk ethnic groups.
A population-based, retrospective cohort study was performed in 738 440 women aged 18-50 years, who delivered babies in Ontario between 1 April 2002 and 31 March 2011. Diabetes incidence postpartum was calculated for each parity and ethnic group. A multivariable analysis of the effect of parity and ethnicity on the incidence of diabetes was performed using a Cox proportional hazards model, adjusting for confounders.
The diabetes incidence rate per 1000 person-years was 3.69 in women with 1 delivery, 4.12 in women with 3 deliveries and 7.62 in women with ≥5 deliveries. Women with ≥3 deliveries had a higher risk of developing diabetes compared with women with 1 delivery [adjusted hazard ratios 1.06 (95% CI 1.01-1.11) for 3 deliveries, 1.33 (95% CI 1.25-1.43) for 4 deliveries and 1.53 (95% CI 1.41-1.66) for ≥5 deliveries). A similar rise in risk could be seen in Chinese and South-Asian women, with the most influence in Chinese women [hazard ratio 4.59 (95% CI 2.36-8.92) for ≥5 deliveries].
There was a positive and graded relationship between increasing parity and risk of development of diabetes. The influence of parity was seen in all ethnicities. This association may be partly related to increasing weight gain and retention with increasing parity, or deterioration in β-cell function. This merits further exploration.
在一个大型基于人群的队列中研究产次增加与糖尿病之间的关系，并检查这种关系在高危种族群体中是否不同。
这是一项基于人群的回顾性队列研究，纳入了 2002 年 4 月 1 日至 2011 年 3 月 31 日期间在安大略省分娩的 738440 名 18-50 岁的女性。为每个产次和族裔群体计算了产后糖尿病的发病率。使用 Cox 比例风险模型对产次和族裔对糖尿病发病率的影响进行多变量分析，调整了混杂因素。
每 1000 人年的糖尿病发病率为 1 次分娩的 3.69%，3 次分娩的 4.12%，≥5 次分娩的 7.62%。与 1 次分娩的女性相比，分娩≥3 次的女性发生糖尿病的风险更高[调整后的风险比 1.06（95%CI 1.01-1.11）为 3 次分娩，1.33（95%CI 1.25-1.43）为 4 次分娩，1.53（95%CI 1.41-1.66）为≥5 次分娩]。这种风险的增加在华裔和南亚裔女性中也可见到，其中华裔女性的影响最大[≥5 次分娩的风险比为 4.59（95%CI 2.36-8.92）]。
产次增加与糖尿病风险之间存在正相关和分级关系。这种关联在所有族裔中都存在。这种关联可能部分与产次增加导致体重增加和保留增加，或β细胞功能恶化有关。这值得进一步探讨。
