Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
Endocrinology Department, Royal Darwin Hospital, Darwin, NT, Australia.
Diabetologia. 2023 May;66(5):837-846. doi: 10.1007/s00125-023-05868-w. Epub 2023 Jan 18.
AIMS/HYPOTHESIS: The aim of this work was to investigate the risk of developing chronic kidney disease (CKD) or end-stage kidney disease (ESKD) following a pregnancy complicated by gestational diabetes mellitus (GDM) or pre-existing diabetes among Aboriginal women in the Northern Territory (NT), Australia.
We undertook a longitudinal study of linked healthcare datasets. All Aboriginal women who gave birth between 2000 and 2016 were eligible for inclusion. Diabetes status in the index pregnancy was as recorded in the NT Perinatal Data Collection. Outcomes included any stage of CKD and ESKD as defined by ICD-10 coding in the NT Hospital Inpatient Activity dataset between 2000 and 2018. Risk was compared using Cox proportional hazards regression.
Among 10,508 Aboriginal women, the mean age was 23.1 (SD 6.1) years; 731 (7.0%) had GDM and 239 (2.3%) had pre-existing diabetes in pregnancy. Median follow-up was 12.1 years. Compared with women with no diabetes during pregnancy, women with GDM had increased risk of CKD (9.2% vs 2.2%, adjusted HR 5.2 [95% CI 3.9, 7.1]) and ESKD (2.4% vs 0.4%, adjusted HR 10.8 [95% CI 5.6, 20.8]). Among women with pre-existing diabetes in pregnancy, 29.1% developed CKD (adjusted HR 10.9 [95% CI 7.7, 15.4]) and 9.9% developed ESKD (adjusted HR 28.0 [95% CI 13.4, 58.6]).
CONCLUSIONS/INTERPRETATION: Aboriginal women in the NT with GDM or pre-existing diabetes during pregnancy are at high risk of developing CKD and ESKD. Pregnancy presents an important opportunity to identify kidney disease risk. Strategies to prevent kidney disease and address the social determinants of health are needed.
目的/假设：本研究旨在调查在澳大利亚北部地区（NT），患有妊娠糖尿病（GDM）或既往糖尿病的孕妇分娩后发生慢性肾脏病（CKD）或终末期肾病（ESKD）的风险。
我们进行了一项基于医疗记录的纵向研究。所有 2000 年至 2016 年间分娩的土著女性都符合纳入条件。索引妊娠期间的糖尿病状态根据 NT 围产期数据收集进行记录。结局包括 2000 年至 2018 年期间 NT 医院住院活动数据集中根据 ICD-10 编码定义的任何阶段的 CKD 和 ESKD。使用 Cox 比例风险回归比较风险。
在 10508 名土著女性中，平均年龄为 23.1（SD 6.1）岁；731 名（7.0%）患有 GDM，239 名（2.3%）患有妊娠期间的既往糖尿病。中位随访时间为 12.1 年。与怀孕期间无糖尿病的女性相比，患有 GDM 的女性发生 CKD 的风险增加（9.2%比 2.2%，调整后的 HR 5.2[95%CI 3.9,7.1]）和 ESKD（2.4%比 0.4%，调整后的 HR 10.8[95%CI 5.6,20.8]）。患有妊娠期间的既往糖尿病的女性中，29.1%发展为 CKD（调整后的 HR 10.9[95%CI 7.7,15.4]），9.9%发展为 ESKD（调整后的 HR 28.0[95%CI 13.4,58.6]）。
结论/解释：NT 的土著女性在怀孕期间患有 GDM 或既往糖尿病，发生 CKD 和 ESKD 的风险很高。怀孕是识别肾脏疾病风险的重要机会。需要制定预防肾脏疾病和解决健康社会决定因素的策略。
