Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Darwin, NT, Australia.
Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
Int J Epidemiol. 2019 Feb 1;48(1):307-318. doi: 10.1093/ije/dyy245.
In Australia's Northern Territory, 33% of babies are born to Indigenous mothers, who experience high rates of hyperglycemia in pregnancy. We aimed to determine the extent to which pregnancy outcomes for Indigenous Australian women are explained by relative frequencies of diabetes type [type 2 diabetes (T2DM) and gestational diabetes (GDM)].
This prospective birth cohort study examined participants recruited from a hyperglycemia in pregnancy register. Baseline data collected were antenatal and perinatal clinical information, cord blood and neonatal anthropometry. Of 1135 women (48% Indigenous), 900 had diabetes: 175 T2DM, 86 newly diagnosed diabetes in pregnancy (DIP) and 639 had GDM. A group of 235 women without hyperglycemia in pregnancy was also recruited.
Diabetes type differed for Indigenous and non-Indigenous women (T2DM, 36 vs 5%; DIP, 15 vs 7%; GDM, 49 vs 88%, p < 0.001). Within each diabetes type, Indigenous women were younger and had higher smoking rates. Among women with GDM/DIP, Indigenous women demonstrated poorer birth outcomes than non-Indigenous women: large for gestational age, 19 vs 11%, p = 0·002; neonatal fat 11.3 vs 10.2%, p < 0.001. In the full cohort, on multivariate regression, T2DM and DIP were independently associated (and Indigenous ethnicity was not) with pregnancy outcomes.
Higher rates of T2DM among Indigenous women predominantly contribute to absolute poorer pregnancy outcomes among Indigenous women with hyperglycemia. As with Indigenous and minority populations globally, prevention or delay of type 2 diabetes in younger women is vital to improve pregnancy outcomes and possibly to improve the long-term health of their offspring.
在澳大利亚北部地区，33%的婴儿是由土著母亲所生，她们在怀孕期间有很高的血糖升高发生率。我们旨在确定澳大利亚土著妇女的妊娠结局在多大程度上可以通过糖尿病类型的相对频率（2 型糖尿病（T2DM）和妊娠期糖尿病（GDM））来解释。
本前瞻性出生队列研究检查了从妊娠高血糖登记处招募的参与者。收集的基线数据包括产前和围产期临床信息、脐带血和新生儿人体测量学。在 1135 名女性（48%为土著人）中，有 900 人患有糖尿病：175 人患有 T2DM，86 人患有新诊断的妊娠糖尿病（DIP），639 人患有 GDM。还招募了一组 235 名没有妊娠高血糖的女性。
糖尿病类型在土著和非土著妇女之间有所不同（T2DM，36%比 5%；DIP，15%比 7%；GDM，49%比 88%，p<0·001）。在每种糖尿病类型中，土著妇女都更年轻，吸烟率更高。在患有 GDM/DIP 的女性中，土著女性的分娩结局比非土著女性差：巨大儿发生率为 19%比 11%，p=0·002；新生儿脂肪 11.3%比 10.2%，p<0·001。在全队列中，多元回归分析显示，T2DM 和 DIP 与妊娠结局独立相关（而土著种族无关）。
土著妇女中 T2DM 的发生率较高，主要导致患有高血糖的土著妇女的妊娠结局绝对较差。与全球的土著和少数族裔一样，预防或延缓年轻女性的 2 型糖尿病对于改善妊娠结局并可能改善其后代的长期健康至关重要。
