McGuire V, Rauh M J, Mueller B A, Hickock D
University of Washington, Department of Epidemiology, Seattle, WA, USA.
Paediatr Perinat Epidemiol. 1996 Jan;10(1):64-72. doi: 10.1111/j.1365-3016.1996.tb00027.x.
Prior studies suggest that diagnosis of gestational diabetes is associated with increased risk for development of gestational diabetes in future pregnancies, and with subsequent onset of established diabetes. The magnitudes of these risks have not been measured. Using linked birth certificate data from Washington State it is possible to identify all women with two or more births occurring during 1984-91. All women with gestational diabetes (n=1375) or with established diabetes (n=220), during their pregnancy for the second or greater birth were identified, and a control group consisting of women whose second or greater birth was not complicated by either condition was randomly selected (n=6380). Data from the birth certificate, for the previous birth, were compared in order to estimate the risks of developing gestational or established diabetes in a subsequent pregnancy among women with prior gestational diabetes relative to women without gestational diabetes. The age-adjusted risk of developing gestational diabetes in the pregnancy for the subsequent birth associated with prior gestational diabetes was 23.2 (95% (confidence interval) CI = 17.2-31.2); the risk of having developed established diabetes by the time of the subsequent birth was 55.5 (95% CI = 34.4-89.4). Women who had a macrosomic infant (>4000 gm) in the prior birth were also at increased risk for developing gestational diabetes (odds ratio OR = 3.3, 95% CI = 2.9-3.8) or established diabetes (OR = 5.8, 95% CI = 4.0-8.5). When data were restricted to patients with only one prior birth, to patients with early prenatal care, to delivery at facilities with long-established protocols for diagnosing gestational diabetes, or to more recent years, the risk estimates remained similarly elevated. The 23-fold increased risk of gestational diabetes associated with having gestational diabetes indicated on the birth certificate of a woman's previous baby, although not unexpected, is still remarkable and reinforces the importance of careful monitoring of women with this history. Although changes in how screening is conducted may account for some of the elevation in risk, our results stayed consistently elevated even when restrictions were made within the data to control for this. The fact that there was a 56-fold increased risk of having developed established diabetes by the time of the subsequent birth on record, associated with prior gestational diabetes, and a 6-fold increased risk associated with a macrosomic infant, supports the idea that these may be early steps in the development of established diabetes, and identifies a group that may benefit from close monitoring and possible intervention.
先前的研究表明，妊娠期糖尿病的诊断与未来妊娠中发生妊娠期糖尿病的风险增加以及随后发生确诊糖尿病有关。这些风险的程度尚未得到衡量。利用华盛顿州的关联出生证明数据，可以识别出在1984 - 1991年期间生育两次或更多次的所有女性。确定了所有在第二次或更高次妊娠期间患有妊娠期糖尿病（n = 1375）或确诊糖尿病（n = 220）的女性，并随机选择了一个对照组，该对照组由第二次或更高次生育未受这两种疾病影响的女性组成（n = 6380）。比较了出生证明上关于前一次生育的数据，以估计先前患有妊娠期糖尿病的女性相对于未患妊娠期糖尿病的女性在随后妊娠中发生妊娠期或确诊糖尿病的风险。与先前的妊娠期糖尿病相关的后续生育中发生妊娠期糖尿病的年龄调整风险为23.2（95%置信区间CI = 17.2 - 31.2）；到后续生育时已发生确诊糖尿病的风险为55.5（95%CI = 34.4 - 89.4）。前一次生育时有巨大儿（>4000克）的女性发生妊娠期糖尿病（优势比OR = 3.3，95%CI = 2.9 - 3.8）或确诊糖尿病（OR = 5.8，95%CI = 4.0 - 8.5）的风险也增加。当数据仅限于只有一次前次生育的患者、接受早期产前护理的患者、在有长期诊断妊娠期糖尿病方案的机构分娩的患者或更近年份的患者时，风险估计值仍同样升高。女性前一个孩子的出生证明上显示患有妊娠期糖尿病与后续生育中发生妊娠期糖尿病的风险增加23倍，尽管并不意外，但仍然很显著，这强化了对有此病史的女性进行仔细监测的重要性。尽管筛查方式的改变可能是风险升高的部分原因，但即使在数据中进行限制以控制这一点，我们的结果仍然持续升高。记录显示，与先前的妊娠期糖尿病相关的后续生育时已发生确诊糖尿病的风险增加56倍，与巨大儿相关的风险增加6倍，这支持了这些可能是确诊糖尿病发展的早期步骤的观点，并确定了一组可能受益于密切监测和可能干预的人群。
