Department of Obstetrics and Gynaecology, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics, Örebro University, Örebro, Sweden.
Diabet Med. 2020 Dec;37(12):2050-2057. doi: 10.1111/dme.14266. Epub 2020 Mar 5.
To assess whether incidence of maternal and neonatal outcomes for women with or without gestational diabetes mellitus (GDM) have changed over time.
Population-based cohort study in Sweden including all singleton pregnancies over the period 1998-2012. GDM was diagnosed following Diabetic Pregnancy Study Group 1991 criteria. Poisson regression or negative binomial regression was used to model yearly relative change in numbers of cases and incidence of the outcomes with 95% confidence intervals (CI), and yearly absolute change in birthweight z-score.
The study included 1 455 667 pregnancies. The number of pregnancies increased over time and the overall prevalence of GDM was 1%. For women with GDM there was a significantly decreasing trend in incidence per year for large for gestational age (LGA) (0.986, 95% CI 0.975 to 0.996), birthweight z-score (-0.012, 95% CI -0.017 to -0.007) and birth trauma (0.937, 95% CI 0.907 to 0.968). The trend for small for gestational age (SGA) among women with GDM increased by an odds ratio per year (1.016, 95% CI 1.002 to 1.029). No significant interaction tests for maternal characteristics were found. Trends in outcomes for women without diabetes were similar to those for women with GDM.
This study shows that there were improvements in pregnancy outcomes for women with GDM between 1998 and 2012, although the incidence of SGA increased. Improvements followed similar trends in the background population. Inequalities in obstetric outcomes between women with GDM and those without have continued unchanged over 15 years, suggesting that new management strategies are required to reduce this gap.
评估患有或不患有妊娠期糖尿病（GDM）的女性的母婴结局发生率是否随时间发生变化。
本研究是一项基于人群的队列研究，在瑞典进行，纳入了 1998 年至 2012 年期间所有的单胎妊娠。GDM 按照 1991 年糖尿病妊娠研究组的标准进行诊断。采用泊松回归或负二项回归模型，以 95%置信区间（CI）计算每年病例数和结局发生率的相对变化，以出生体重 z 分数计算每年的绝对变化。
研究共纳入 1 455 667 例妊娠。随着时间的推移，妊娠例数不断增加，GDM 的总体患病率为 1%。对于患有 GDM 的女性，巨大儿（LGA）的发生率呈显著下降趋势（每年 0.986，95%CI 0.975 至 0.996）、出生体重 z 分数（每年-0.012，95%CI-0.017 至-0.007）和分娩创伤（每年 0.937，95%CI 0.907 至 0.968）。患有 GDM 的女性中，小于胎龄儿（SGA）的发生率呈逐年上升趋势，每年的比值比为 1.016（95%CI 1.002 至 1.029）。未发现母体特征的交互检验具有统计学意义。无糖尿病女性的结局趋势与 GDM 女性相似。
本研究表明，1998 年至 2012 年间，患有 GDM 的女性的妊娠结局有所改善，尽管 SGA 的发生率有所增加。改善趋势与背景人群相似。患有 GDM 的女性与无 GDM 的女性之间的产科结局不平等状况在 15 年期间没有变化，表明需要采取新的管理策略来缩小这一差距。
