School of Population and Public Health (Nethery, Law, Kotaska, Janssen, Hutcheon), The University of British Columbia; Centre for Health Services and Policy Research (Law), The University of British Columbia, Vancouver, BC; Department of Obstetrics & Gynecology (Kotaska), University of Manitoba, Winnipeg, Man.; British Columbia Children's Hospital Research Institute (Janssen); Department of Obstetrics & Gynaecology (Hutcheon), The University of British Columbia, Vancouver, BC
School of Population and Public Health (Nethery, Law, Kotaska, Janssen, Hutcheon), The University of British Columbia; Centre for Health Services and Policy Research (Law), The University of British Columbia, Vancouver, BC; Department of Obstetrics & Gynecology (Kotaska), University of Manitoba, Winnipeg, Man.; British Columbia Children's Hospital Research Institute (Janssen); Department of Obstetrics & Gynaecology (Hutcheon), The University of British Columbia, Vancouver, BC.
CMAJ. 2023 Mar 20;195(11):E396-E403. doi: 10.1503/cmaj.221404.
Rates of gestational diabetes are reported to be increasing in many jurisdictions, but the reasons for this are poorly understood. We sought to evaluate the relative contribution of screening practices for gestational diabetes (including completion and methods of screening) and population characteristics to risk of gestational diabetes in British Columbia, Canada, from 2005 to 2019.
We used a population-based cohort from a provincial registry of perinatal data, linked to laboratory billing records. We used data on screening completion, screening method (1-step 75-g glucose test or 2-step approach of 50-g glucose screening test, followed by a diagnostic test for patients who screen positive) and demographic risk factors. We modelled predicted annual risk for gestational diabetes, sequentially adjusted for screening completion, screening method and risk factors.
We included 551 457 pregnancies in the study cohort. The incidence of gestational diabetes more than doubled over the study period, from 7.2% in 2005 to 14.7% in 2019. Screening completion increased from 87.2% in 2005 to 95.5% in 2019. Use of 1-step screening methods increased from 0.0% in 2005 to 39.5% in 2019 among those who were screened. Unadjusted models estimated a 2.04 (95% confidence interval [CI] 1.94-2.13) increased risk of gestational diabetes in 2019 (v. 2005). This increase was 1.89 (95% CI 1.81-1.98) after accounting for the rise in screening completion and 1.34 (95% CI 1.28-1.40) after accounting for changes in screening methods. Further accounting for demographic risk factors (e.g., age, body mass index, prenatal care) had a small impact (increase of 1.25, 95% CI 1.19-1.31).
Most of the observed increase in the incidence of gestational diabetes was attributable to changes in screening practices (primarily changes in screening methods) rather than changing population factors. Our findings highlight the importance of understanding variation in screening practices when monitoring incidence rates for gestational diabetes.
许多司法管辖区都报告妊娠期糖尿病的发病率在上升，但原因尚不清楚。我们试图评估 2005 年至 2019 年期间不列颠哥伦比亚省（加拿大）妊娠糖尿病筛查（包括完成情况和筛查方法）和人口特征对妊娠糖尿病风险的相对贡献。
我们使用了省级围产期数据登记处的基于人群的队列，并与实验室计费记录相关联。我们使用了筛查完成情况、筛查方法（一步 75g 葡萄糖试验或两步法，先对 50g 葡萄糖筛查试验阳性的患者进行诊断性检查）和人口统计学风险因素的数据。我们对妊娠糖尿病的预测年发病率进行了建模，依次调整了筛查完成情况、筛查方法和风险因素。
我们的研究队列纳入了 551457 例妊娠。在研究期间，妊娠期糖尿病的发病率翻了一番多，从 2005 年的 7.2%上升到 2019 年的 14.7%。筛查完成率从 2005 年的 87.2%上升到 2019 年的 95.5%。在接受筛查的人群中，一步筛查方法的使用率从 2005 年的 0.0%上升到 2019 年的 39.5%。未调整模型估计 2019 年（与 2005 年相比）妊娠期糖尿病的风险增加了 2.04（95%置信区间[CI] 1.94-2.13）。这一增长在考虑到筛查完成率上升后为 1.89（95%CI 1.81-1.98），在考虑到筛查方法变化后为 1.34（95%CI 1.28-1.40）。进一步考虑人口统计学风险因素（如年龄、体重指数、产前护理）的影响较小（增加 1.25，95%CI 1.19-1.31）。
观察到的妊娠期糖尿病发病率的增加主要归因于筛查实践的变化（主要是筛查方法的变化），而不是人口因素的变化。我们的研究结果强调了在监测妊娠期糖尿病发病率时了解筛查实践差异的重要性。
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