Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Can J Diabetes. 2020 Oct;44(7):605-614. doi: 10.1016/j.jcjd.2019.11.001. Epub 2019 Nov 20.
Because of disparities in incidence of diabetes in pregnancy (DIP) among First Nations (FN) and non-First Nations (non-FN) women in Saskatchewan, we compared predictors and early maternal/child complication rates of gestational diabetes (GDM) and pre-GDM between the 2 populations from 1980 to 2013.
Using Ministry of Health administrative databases, we examined overall GDM and pre-GDM predictors among a cohort of FN and non-FN women using logistic regression models. We compared early birth complications by ethnicity and DIP status using chi-square analysis.
Deidentified data were obtained for 69,176 FN and 344,410 non-FN pregnancies. Important GDM and pre-GDM predictors for FN and non-FN pregnancies were increasing maternal age, a previous high birthweight (HBW) or stillborn infant, and, most importantly, previous maternal GDM. Both GDM and pre-GDM were over 2.3-fold as likely to occur among FN in multivariable analysis. FN and non-FN pregnancies with GDM and pre-GDM had higher rates of prematurity, shoulder dystocia, caesarean section, HBW and stillborn and infant death than those with no DIP. The largest rate disparities between FN and non-FN with DIP occurred with stillborn, HBW and shoulder dystocia.
Along with previously recognized predictors of GDM and pre-GDM, FN ethnicity was an independent determinant of DIP in Saskatchewan from 1980 to 2013. Early mother/child birth complications were increased in both FN and non-FN with DIP, but more so in FN. Effective DIP prevention strategies, and improvements in preconception, prenatal and perinatal care, are required to remove ethnicity-based disparities in DIP rates and outcomes.
萨斯喀彻温省原住民（FN）和非原住民（non-FN）女性妊娠糖尿病（DIP）发病率存在差异，本研究比较了 1980 年至 2013 年期间这两个群体的妊娠期糖尿病（GDM）和预 GDM 的预测因素及母婴早期并发症发生率。
利用卫生部行政数据库，本研究采用逻辑回归模型，对 FN 和 non-FN 女性队列的整体 GDM 和预 GDM 预测因素进行了研究。采用卡方检验比较了不同种族和 DIP 状态下的早期出生并发症。
获得了 69176 例 FN 和 344410 例 non-FN 妊娠的匿名数据。FN 和 non-FN 妊娠的重要 GDM 和预 GDM 预测因素包括母亲年龄增加、既往巨大儿（HBW）或死产儿，以及最重要的既往母体 GDM。多变量分析中，FN 妊娠发生 GDM 和预 GDM 的可能性是 non-FN 的 2.3 倍以上。患有 GDM 和预 GDM 的 FN 和 non-FN 妊娠的早产、肩难产、剖宫产、HBW 和死产及婴儿死亡的发生率高于无 DIP 的妊娠。FN 和 non-FN 妊娠的 DIP 与死产、HBW 和肩难产的发生率差异最大。
除了先前公认的 GDM 和预 GDM 预测因素外，FN 种族也是萨斯喀彻温省 1980 年至 2013 年 DIP 的独立决定因素。无论种族，患有 DIP 的母亲/婴儿的早期分娩并发症均增加，但 FN 更为明显。需要制定有效的 DIP 预防策略，并改善孕前、产前和围产期保健，以消除基于种族的 DIP 发生率和结局差异。
