萨斯喀彻温省原住民和非原住民女性中妊娠糖尿病对糖尿病风险的影响：DIP：ORRIIGENSS 项目的结果。
The Contribution of Gestational Diabetes to Diabetes Risk Among First Nations and Non-First Nations Women in Saskatchewan: Results From the DIP: ORRIIGENSS Project.
机构信息
Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Department of Medicine, Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
出版信息
Can J Diabetes. 2023 Aug;47(6):509-518. doi: 10.1016/j.jcjd.2023.04.017. Epub 2023 May 6.
OBJECTIVES
Our aim in this study was to determine the risk for diabetes mellitus (DM) among Saskatchewan First Nations (FN) and non-FN women with prior gestational DM (GDM).
METHODS
Using Ministry of Health administrative databases, we conducted a retrospective cohort study of DM risk by GDM occurrence among FN and non-FN women giving birth from 1980 to 2009 and followed to March 31, 2013. We determined frequencies and odds ratios (ORs) of DM in women with/without prior GDM after stratifying by FN status, while adjusting for other DM determinants. Survival curves of women until DM diagnosis were obtained by prior GDM occurrence and stratified by ethnicity and total parity.
RESULTS
De-identified data were obtained for 202,588 women. Of those who developed DM, 2,074 of 10,114 (20.5%) had previously experienced GDM (811 of 3,128 [25.9%]) FN and 1,263 of 6,986 [18.1%] non-FN). Cumulative survival of women with prior GDM until DM was higher for FN than for non-FN women (82% vs 46%), but prior GDM was a stronger predictor of DM within the non-FN cohort (prior GDM vs no GDM: OR, 9.64 for non-FN; OR, 7.05 for FN). Finally, higher total parity interacted with prior GDM to increase DM risk in both groups. With prior GDM and parity ≥3, 93% of FN and 57% of non-FN women subsequently developed DM.
CONCLUSIONS
GDM is a leading determinant of T2DM among FN and non-FN women, amplified by higher parity. This contributes to earlier onset diabetes, affecting subsequent pregnancies and increasing risk for chronic diabetic complications. It may also factor into higher type 2 DM rates observed in FN women compared with men.
目的
本研究旨在确定曾患有妊娠糖尿病（GDM）的萨斯喀彻温省第一民族（FN）和非 FN 女性发生糖尿病（DM）的风险。
方法
我们利用卫生部行政数据库，对 1980 年至 2009 年分娩的 FN 和非 FN 女性进行了 GDM 发病后 DM 风险的回顾性队列研究，并随访至 2013 年 3 月 31 日。我们确定了在按 FN 状态分层的情况下，有/无既往 GDM 的女性发生 DM 的频率和比值比（OR），同时调整了其他 DM 决定因素。通过既往 GDM 的发生获得了 DM 诊断前女性的生存曲线，并按种族和总产次进行分层。
结果
获得了 202588 名女性的匿名数据。在发生 DM 的人群中，有 2074 名（20.5%）曾经历过 GDM（FN 中 811 名[25.9%]，非 FN 中 1263 名[18.1%]）。有既往 GDM 的女性直到 DM 的累积生存率 FN 高于非 FN 女性（82% vs 46%），但既往 GDM 是非 FN 队列中 DM 的更强预测因素（既往 GDM 与无 GDM：OR，9.64 为非 FN；OR，7.05 为 FN）。最后，总产次较高与既往 GDM 相互作用，增加了两组的 DM 风险。既往 GDM 且产次≥3 的情况下，FN 中有 93%的女性和非 FN 中有 57%的女性随后发生 DM。
结论
GDM 是 FN 和非 FN 女性 T2DM 的主要决定因素，较高的产次会使其加剧。这会导致更早的发病，影响后续妊娠并增加慢性糖尿病并发症的风险。它也可能是 FN 女性与男性相比，2 型糖尿病发生率较高的原因之一。
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