Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri.
Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri.
J Womens Health (Larchmt). 2020 May;29(5):609-621. doi: 10.1089/jwh.2019.8081. Epub 2020 Feb 19.
Fifty percent of women with gestational diabetes mellitus (GDM) may progress to type 2 diabetes with highest risk among black women. This study aims to characterize postpartum diabetes screening rates among U.S. women with GDM by racial and ethnic group to characterize potential disparities. A standardized search of Ovid-Medline, Embase, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, ProQuest, and Clinicaltrials.gov was conducted through October 12, 2018. Of 1,555 titles reviewed, 27 studies met inclusion criteria. Meta-proportion routines with random-effects models estimated pooled postpartum screening proportion effect size (ES) with 95% confidence interval (CI) by racial and ethnic group. Heterogeneity was measured using Cochrane's Q and Higgins tests. Data were stratified by intervention and data source. There were 96,439 women, of whom 81,930 had race/ethnicity recorded. Heterogeneity was high ( = 99.7%). Postpartum screening rates were low (pooled ES 42% [95% CI 35%-48%]). Point estimates for pooled screening proportions were lower among white (pooled ES 35% [95% CI 28%-42%]) and black (pooled ES 33% [95% CI 24%-42%]) women than among Hispanic (pooled ES 45% [95% CI 37%-53%]) and Asian (pooled ES 50% [95% CI 41%-58%]) women. Interventions to improve screening were most common and effective among Hispanic women. Postpartum screening for diabetes after GDM remains low, and black women have among the lowest postpartum screening rates despite highest risk for type 2 diabetes progression. Reporting of race/ethnicity, screening methods, and screening time frames varied across studies. Future studies must standardize racial/ethnic data reporting and examine interventions that address postpartum diabetes screening and prevention.
50%患有妊娠糖尿病（GDM）的女性可能会发展为 2 型糖尿病，其中黑人女性的风险最高。本研究旨在通过种族和族裔群体来描述美国患有 GDM 的女性产后糖尿病筛查率，以描述潜在的差异。通过 Ovid-Medline、Embase、Scopus、护理和联合健康文献累积索引（CINAHL）、Cochrane、ProQuest 和 Clinicaltrials.gov 对文献进行了标准化搜索，截至 2018 年 10 月 12 日。在审查的 1555 篇标题中，有 27 项研究符合纳入标准。使用随机效应模型的 Meta-比例例程估计了按种族和族裔群体分层的产后筛查比例效应大小（ES）的汇总值，置信区间（CI）为 95%。使用 Cochrane 的 Q 和 Higgins 检验来衡量异质性。根据干预措施和数据源对数据进行分层。共有 96439 名女性，其中 81930 名女性记录了种族/族裔。异质性很高（ = 99.7%）。产后筛查率较低（汇总 ES 为 42%[95%CI 35%-48%]）。白人（汇总 ES 为 35%[95%CI 28%-42%]）和黑人（汇总 ES 为 33%[95%CI 24%-42%]）女性的汇总筛查比例估计值低于西班牙裔（汇总 ES 为 45%[95%CI 37%-53%]）和亚裔（汇总 ES 为 50%[95%CI 41%-58%]）女性。改善筛查的干预措施在西班牙裔女性中最为常见和有效。妊娠糖尿病后糖尿病的产后筛查仍然很低，尽管黑人女性发生 2 型糖尿病进展的风险最高，但她们的产后筛查率最低。研究报告的种族/族裔、筛查方法和筛查时间框架在不同的研究中存在差异。未来的研究必须规范种族/族裔数据报告，并研究解决产后糖尿病筛查和预防的干预措施。
