From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH.
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Am J Obstet Gynecol MFM. 2023 Jan;5(1):100785. doi: 10.1016/j.ajogmf.2022.100785. Epub 2022 Oct 22.
The rate of gestational diabetes mellitus has increased over the past decade. An age, period, and cohort epidemiologic analysis can be used to understand how and why disease trends have changed over time.
This study aimed to estimate the associations of age (at delivery), period (delivery year), and cohort (birth year) of the pregnant individual with trends in the incidence of gestational diabetes mellitus in the United States.
We conducted an age, period, and cohort analysis of nulliparous pregnant adults aged 18 to 44 years with singleton live births from the National Vital Statistics System from 2011 to 2019. Generalized linear mixed models were used to calculate the adjusted rate ratios for the incidence of gestational diabetes mellitus for each 3-year maternal age span, period, and cohort group compared with the reference group for each. We repeated the analyses with stratification according to self-reported racial and ethnic group (non-Hispanic Asian-Pacific Islander, non-Hispanic Black, Hispanic, and non-Hispanic White) because of differences in the incidence of and risk factors for gestational diabetes mellitus by race and ethnicity.
Among 11,897,766 pregnant individuals, 5.2% had gestational diabetes mellitus. The incidence of gestational diabetes mellitus was higher with increasing 3-year maternal age span, among those in the more recent delivery period, and among the younger birth cohort. For example, individuals aged 42 to 44 years at delivery had a 5-fold higher risk for gestational diabetes mellitus than those aged 18 to 20 years (adjusted rate ratio, 5.57; 95% confidence interval, 5.43-5.72) after adjusting for cohort and period. Individuals who delivered between 2017 and 2019 were at higher risk for gestational diabetes mellitus than those who delivered between 2011 and 2013 (adjusted rate ratio, 1.24; 95% confidence interval, 1.23-1.25) after adjusting for age and cohort. Individuals born between 1999 and 2001 had a 3-fold higher risk for gestational diabetes mellitus than those born between 1969 and 1971 (adjusted rate ratio, 3.12; 95% confidence interval, 2.87-3.39) after adjusting for age and period. Similar age, period, and cohort effects were observed for the assessed racial and ethnic groups, with the greatest period effects observed among Asian and Pacific Islander individuals.
Period and birth cohort effects have contributed to the rising incidence of gestational diabetes mellitus in the United States from 2011 to 2019.
在过去的十年中，妊娠糖尿病的发病率有所上升。年龄、时期和队列的流行病学分析可以帮助我们了解疾病趋势是如何以及为何随时间而变化的。
本研究旨在估计孕妇的年龄（分娩时）、时期（分娩年份）和队列（出生年份）与美国妊娠糖尿病发病率变化的关联。
我们对 2011 年至 2019 年来自国家生命统计系统的 18 至 44 岁的单胎活产的未生育成年孕妇进行了年龄、时期和队列分析。使用广义线性混合模型计算了每个 3 年的产妇年龄跨度、时期和队列组与参考组相比，妊娠糖尿病发病率的调整率比值。由于种族和民族（非西班牙裔亚裔-太平洋岛民、非西班牙裔黑人、西班牙裔和非西班牙裔白人）之间妊娠糖尿病的发病率和风险因素存在差异，我们根据自我报告的种族和民族进行了分层分析。
在 11897766 名孕妇中，有 5.2%患有妊娠糖尿病。随着产妇年龄跨度每增加 3 年、分娩时期越接近最近以及出生队列越年轻，妊娠糖尿病的发病率越高。例如，与 18 至 20 岁年龄组相比，分娩时年龄在 42 至 44 岁的个体妊娠糖尿病的风险高 5 倍（调整后的率比，5.57；95%置信区间，5.43-5.72），经队列和时期调整后。与 2011 年至 2013 年分娩的孕妇相比，2017 年至 2019 年分娩的孕妇患妊娠糖尿病的风险更高（调整后的率比，1.24；95%置信区间，1.23-1.25），经年龄和队列调整后。与 1969 年至 1971 年出生的个体相比，1999 年至 2001 年出生的个体妊娠糖尿病的风险高 3 倍（调整后的率比，3.12；95%置信区间，2.87-3.39），经年龄和时期调整后。在评估的种族和民族群体中，也观察到了类似的年龄、时期和队列效应，其中亚洲和太平洋岛民个体的时期效应最大。
时期和出生队列效应对 2011 年至 2019 年美国妊娠糖尿病发病率的上升起了作用。
