妊娠糖尿病与儿童和青少年期新发糖尿病相关：一项回顾性队列研究。
Gestational diabetes associated with incident diabetes in childhood and youth: a retrospective cohort study.
机构信息
Department of Medicine (Blotsky, Rahme, Dasgupta), McGill University; Centre for Outcomes Research and Evaluation (Blotsky, Rahme, Dahhou, Nakhla, Dasgupta), Research Institute of the McGill University Health Centre; Department of Pediatrics (Nakhla), Division of Endocrinology and Metabolism, McGill University, Montréal, Que.
出版信息
CMAJ. 2019 Apr 15;191(15):E410-E417. doi: 10.1503/cmaj.181001.
BACKGROUND
Indicators of childhood- and youth-onset diabetes may be useful for early detection of diabetes; there is a known association between composite exposure of parental type 2 diabetes and gestational diabetes mellitus with childhood- and youth-onset diabetes. We examined associations between gestational diabetes mellitus and incidence of childhood- and youth-onset diabetes in offspring.
METHODS
Using public health insurance administrative databases from Quebec, Canada, we randomly selected singleton live births with maternal gestational diabetes mellitus (1990-2007) and matched them 1:1 with singleton live births without gestational diabetes mellitus. Follow-up was to Mar. 31, 2012. We examined associations of diabetes in offspring with maternal gestational diabetes mellitus through unadjusted and adjusted Cox proportional hazards models. In secondary analyses, we separately considered age groups ranging from birth to age 12 years, and age 12 to 22 years.
RESULTS
Incidence of pediatric diabetes (per 10 000 person-years) was higher in offspring born to mothers with gestational diabetes mellitus (4.52, 95% confidence interval [CI] 4.47-4.57) than in mothers without gestational diabetes mellitus (2.4, 95% CI 2.37-2.46). In an adjusted Cox proportional hazards model, maternal gestational diabetes mellitus was associated with development of pediatric diabetes overall (birth to age 22 yr: hazard ratio [HR] 1.77, 95% CI 1.41-2.22), during childhood (birth to age 12 yr: HR 1.43, 95% CI 1.09-1.89), and in youth (age 12 to 22 yr: HR 2.53, 95% CI 1.67-3.85).
INTERPRETATION
Gestational diabetes mellitus is associated with incident diabetes in offspring during childhood and adolescence. Future studies are needed to examine longer-term outcomes in patients with pediatric diabetes with a maternal history of gestational diabetes mellitus, to ascertain how they compare with other patients with childhood- or youth-onset diabetes, in terms of disease severity and outcomes.
背景
儿童和青少年期发病的糖尿病的指标可能有助于早期发现糖尿病；已知父母 2 型糖尿病和妊娠糖尿病的综合暴露与儿童和青少年期发病的糖尿病有关。我们研究了妊娠糖尿病与后代儿童和青少年期发病的糖尿病之间的关联。
方法
我们使用来自加拿大魁北克的公共医疗保险行政数据库，随机选择患有母亲妊娠糖尿病的单胎活产儿（1990-2007 年），并将其与没有妊娠糖尿病的单胎活产儿 1:1 匹配。随访至 2012 年 3 月 31 日。我们通过未调整和调整后的 Cox 比例风险模型研究了后代糖尿病与母亲妊娠糖尿病之间的关联。在二次分析中，我们分别考虑了从出生到 12 岁和 12 至 22 岁的年龄组。
结果
患有母亲妊娠糖尿病的后代中儿科糖尿病（每 10000 人年发病）的发生率（每 10000 人年发病）高于没有妊娠糖尿病的母亲（4.52，95%置信区间 [CI] 4.47-4.57）。在调整后的 Cox 比例风险模型中，母亲妊娠糖尿病与儿科糖尿病的总体发展相关（从出生到 22 岁：风险比 [HR] 1.77，95%CI 1.41-2.22），在儿童期（从出生到 12 岁：HR 1.43，95%CI 1.09-1.89），以及在青少年期（12 至 22 岁：HR 2.53，95%CI 1.67-3.85）。
解释
妊娠糖尿病与儿童和青少年期后代发病的糖尿病有关。需要进一步研究以检查患有妊娠糖尿病的儿科糖尿病患者的长期结局，以确定他们在疾病严重程度和结局方面与其他儿童或青少年期发病的糖尿病患者相比如何。
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