School of Public Health (Voaklander, Eurich), and Department of Obstetrics and Gynecology (Sanni, Serrano-Lomelin, Ospina), University of Alberta; Métis Nation of Alberta (James, Cordingley, Bartel), Edmonton, Alta.; Department of Public Health Sciences (Ospina), Queen's University, Kingston, Ont.
CMAJ. 2023 Nov 20;195(45):E1533-E1542. doi: 10.1503/cmaj.230175.
Diabetes in pregnancy is an important public health concern for Indigenous populations. We sought to evaluate the prevalence and outcomes of pre-existing and gestational diabetes among Métis pregnancies compared with other pregnancies in Alberta, Canada.
We conducted a retrospective cohort study using administrative health data from 2006 to 2016 and the Métis Nation of Alberta Identification Registry to compare the prevalence of pre-existing and gestational diabetes among all singleton Métis births with non-Métis births. We compared 10 maternal and neonatal outcomes using adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in multivariable analyses.
The study population included 7902 Métis and 471 886 non-Métis births. The age-standardized prevalence of pre-existing diabetes was 1.7% (95% CI 1.4%-2.1%) for Métis and 1.1% (95% CI 1.1%-1.2%) for non-Métis pregnancies. For gestational diabetes, the age-standardized prevalence was 6.3% (95% CI 5.6%-6.9%) for Métis and 5.4% (95% CI 5.3%-5.4%) for non-Métis pregnancies. After adjusting for parity, maternal weight, age, smoking during pregnancy and material and social deprivation, Métis pregnancies had 1.72 times higher prevalence of preexisting diabetes (adjusted OR 1.72, 95% CI 1.15-2.56) and 1.30 times higher prevalence of gestational diabetes (adjusted OR 1.30, 95% CI 1.08-1.57) than non-Métis pregnancies. Métis pregnancies with pre-existing diabetes had nearly 3 times the odds of developing preeclampsia (adjusted OR 2.96, 95% CI 1.27-6.90), while those with gestational diabetes had 48% higher odds of large-for-gestational-age infants (adjusted OR 1.48, 95% CI 1.00-2.19).
Métis pregnancies have an increased prevalence of pre-existing and gestational diabetes than non-Métis pregnancies and an elevated risk of some perinatal outcomes. Interventions to tackle these health inequities should address both physiologic and cultural dimensions of health, informed by Métis perspectives.
妊娠糖尿病是影响原住民人口的重要公共卫生问题。我们旨在评估与加拿大艾伯塔省其他妊娠相比，梅蒂斯妊娠中孕前和妊娠期糖尿病的患病率和结局。
我们使用 2006 年至 2016 年的行政健康数据和梅蒂斯民族艾伯塔省身份登记处进行了回顾性队列研究，比较了所有单胎梅蒂斯分娩与非梅蒂斯分娩的孕前和妊娠期糖尿病的患病率。我们使用调整后的优势比（OR）和 95%置信区间（CI）在多变量分析中比较了 10 种母婴结局。
研究人群包括 7902 名梅蒂斯人和 471886 名非梅蒂斯人。梅蒂斯妊娠中孕前糖尿病的年龄标准化患病率为 1.7%（95%CI 1.4%-2.1%），而非梅蒂斯妊娠中为 1.1%（95%CI 1.1%-1.2%）。对于妊娠期糖尿病，梅蒂斯妊娠的年龄标准化患病率为 6.3%（95%CI 5.6%-6.9%），而非梅蒂斯妊娠中为 5.4%（95%CI 5.3%-5.4%）。调整了产次、母亲体重、年龄、孕期吸烟以及物质和社会剥夺因素后，与非梅蒂斯妊娠相比，梅蒂斯妊娠的孕前糖尿病患病率高出 1.72 倍（调整后的 OR 1.72，95%CI 1.15-2.56），妊娠期糖尿病患病率高出 1.30 倍（调整后的 OR 1.30，95%CI 1.08-1.57）。患有孕前糖尿病的梅蒂斯妊娠发生子痫前期的可能性几乎增加了 3 倍（调整后的 OR 2.96，95%CI 1.27-6.90），而患有妊娠期糖尿病的梅蒂斯妊娠巨大儿的风险增加了 48%（调整后的 OR 1.48，95%CI 1.00-2.19）。
与非梅蒂斯妊娠相比，梅蒂斯妊娠的孕前和妊娠期糖尿病患病率更高，一些围产期结局的风险也更高。解决这些健康不平等问题的干预措施应同时针对健康的生理和文化维度，并借鉴梅蒂斯人的观点。
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