From the Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas.
South Med J. 2022 Jul;115(7):405-413. doi: 10.14423/SMJ.0000000000001418.
Racial disparities in preexisting diabetes mellitus (PDM) and gestational diabetes mellitus (GDM) remain largely unexplored. We examined national PDM and GDM prevalence trends by race/ethnicity and the association between these conditions and fetal death.
This was a retrospective cross-sectional analysis of 69,539,875 pregnancy-related hospitalizations from 2002 to 2017 including 674,040 women with PDM (1.0%) and 2,960,797 (4.3%) with GDM from the US Nationwide Inpatient Sample Survey. Joinpoint regression was used to evaluate trends in prevalence. Survey logistic regression was used to evaluate the association between exposures (PDM and GDM) and outcome.
Overall, the average annual increase in prevalence was 5.2% (95% confidence interval [CI] 4.2-6.2) for GDM and 1.0% (95% CI -0.1 to 2.0) for PDM, during the study period. Hispanic (average annual percentage change 5.3, 95% CI 3.6 - 7.1) and non-Hispanic Black (average annual percentage change 0.9, 95% CI 0.1 - 1.7) women had the highest average annual percentage increase in the prevalence of GDM and PDM, respectively. After adjustment, the odds of stillbirth were highest for Hispanic women with PDM (odds ratio 2.41, 95% CI 2.23-2.60) and decreased for women with GDM (odds ratio 0.51, 95% CI 0.50-0.53), irrespective of race/ethnicity.
PDM and GDM prevalence is increasing in the United States, with the highest average annual percentage changes seen among minority women. Furthermore, the reasons for the variation in the occurrence of stillbirths among mothers with PDM and GDM by race/ethnicity are not clear and warrant additional research.
种族间糖尿病前期（PDM）和妊娠糖尿病（GDM）的差异仍很大程度上尚未得到探索。我们研究了按种族/族裔划分的全国 PDM 和 GDM 患病率趋势，以及这些情况与胎儿死亡之间的关联。
这是一项回顾性的横断面分析，涉及 2002 年至 2017 年的 69539875 例妊娠相关住院治疗，其中包括 674040 例 PDM（1.0%）和 2960797 例 GDM（4.3%），来自美国全国住院患者样本调查。使用 Joinpoint 回归评估患病率趋势。使用调查逻辑回归评估暴露（PDM 和 GDM）与结局之间的关联。
总体而言，在研究期间，GDM 的患病率平均每年增加 5.2%（95%置信区间[CI] 4.2-6.2），PDM 的患病率平均每年增加 1.0%（95%CI -0.1 至 2.0）。西班牙裔（平均年百分比变化 5.3，95%CI 3.6-7.1）和非西班牙裔黑人（平均年百分比变化 0.9，95%CI 0.1-1.7）女性的 GDM 和 PDM 患病率的平均年百分比增加最高。调整后，PDM 西班牙裔女性的死产几率最高（比值比 2.41，95%CI 2.23-2.60），而 GDM 女性的死产几率降低（比值比 0.51，95%CI 0.50-0.53），与种族/族裔无关。
在美国，PDM 和 GDM 的患病率正在上升，少数民族妇女的平均年百分比变化最大。此外，种族/族裔之间 PDM 和 GDM 母亲死产发生率差异的原因尚不清楚，需要进一步研究。
