基于最新国际诊断标准的非洲妊娠期糖尿病患病率及影响因素：系统评价与荟萃分析
Prevalence and determinants of gestational diabetes mellitus in Africa based on the updated international diagnostic criteria: a systematic review and meta-analysis.
作者信息
Muche Achenef Asmamaw, Olayemi Oladapo O, Gete Yigzaw Kebede
机构信息
1Department of Obstetrics and Gynaecology, College of Medicine, Pan African University Life and Earth Sciences Institutes, University of Ibadan, Ibadan, Nigeria.
3Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
出版信息
Arch Public Health. 2019 Aug 6;77:36. doi: 10.1186/s13690-019-0362-0. eCollection 2019.
BACKGROUND
Gestational diabetes mellitus (GDM) is a major public health problem and threat to maternal and child health in Africa. No prior review has been conducted in Africa using the updated GDM diagnostic criteria. Therefore, this review aimed to estimate the pooled prevalence and determinants of GDM in Africa by using current international diagnostic criteria.
METHODS
A systematic review and meta-analysis was conducted by comprehensive search of the published studies in Africa. Electronic databases (PubMed, Scopus, Cochrane Library, EMBASE, Google Scholar, CINAHL, Web of Science, Science direct and African Journals Online) were searched using relevant search terms. Data were extracted on an excel sheet and Stata/ SE 14.0 software was used to perform the meta-analysis. Heterogeneity of included studies were assessed using and Q test statistics. I > 50% and Q test with its respective -value < 0.05 were suggestive for the presence of a significant heterogeneity. Publication bias was assessed using the Egger's regression test and funnel plot. Subgroup and sensitivity analyses were done. A random effects model was used to estimate the pooled prevalence of GDM and odds ratio (OR) with 95% confidence interval (CI).
RESULT
A total of 23 studies were included in the final analysis. The pooled prevalence of GDM in Africa was 13.61% (95% CI: 10.99, 16.23; I = 96.1%), and 14.28% (95% CI, 11.39, 17.16; I = 96.4%) in the sub-Saharan African region. The prevalence was highest in Central Africa 20.4% (95% CI, 1.55, 38.54), and lowest in Northern Africa 7.57% (95% CI, 5.89, 9.25) sub- regions. Overweight and obesity, macrosomia, family history of diabetes, history of stillbirth, history of abortion, chronic hypertension and history of previous GDM had positively associated with GDM.
CONCLUSIONS
The prevalence of GDM is high in Africa. Being overweighed and/or obese, ever had macrocosmic baby, family history of diabetes, history of stillbirth, history of abortion or miscarriage, chronic hypertension and history of previous GDM were factors associated with GDM. Preventing overweighed and obese, giving due attention to women having high-risk cases for GDM in pregnancy are strongly recommended to mitigate the burden.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (2018:CRD42018116843).
背景
妊娠期糖尿病（GDM）是非洲一个主要的公共卫生问题，对母婴健康构成威胁。此前非洲尚未使用更新后的GDM诊断标准进行过综述。因此，本综述旨在采用当前国际诊断标准估计非洲GDM的合并患病率及其决定因素。
方法
通过全面检索非洲已发表的研究进行系统综述和荟萃分析。使用相关检索词在电子数据库（PubMed、Scopus、Cochrane图书馆、EMBASE、谷歌学术、CINAHL、科学网、科学Direct和非洲在线期刊）中进行检索。数据提取到Excel表格中，并使用Stata/SE 14.0软件进行荟萃分析。使用I²和Q检验统计量评估纳入研究的异质性。I²>50%且Q检验及其相应的P值<0.05提示存在显著异质性。使用Egger回归检验和漏斗图评估发表偏倚。进行亚组分析和敏感性分析。采用随机效应模型估计GDM的合并患病率和比值比（OR）及其95%置信区间（CI）。
结果
最终分析共纳入23项研究。非洲GDM的合并患病率为13.61%（95%CI：10.99，16.23；I²=96.1%），撒哈拉以南非洲地区为14.28%（95%CI，11.39，17.16；I²=96.4%）。患病率在中部非洲最高，为20.4%（95%CI，1.55，38.54），在北非次区域最低，为7.57%（95%CI，5.89，9.25）。超重和肥胖、巨大儿、糖尿病家族史、死产史、流产史、慢性高血压和既往GDM史与GDM呈正相关。
结论
非洲GDM患病率较高。超重和/或肥胖、曾有巨大儿、糖尿病家族史、死产史、流产或堕胎史、慢性高血压和既往GDM史是与GDM相关的因素。强烈建议预防超重和肥胖，孕期关注GDM高危女性，以减轻负担。
系统综述注册
PROSPERO（2018：CRD42018116843）
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