小柯机器人

美国俄亥俄州立大学Mark B. Landon团队研究了2014-2020年美国妊娠期糖尿病患者不良妊娠结局的风险，并按照族裔和民族进行分层。2022年4月12日出版的《美国医学会杂志》发表了这项最新研究成果。

妊娠期糖尿病增加了不良妊娠结局的风险，在美国所有族裔和民族亚群中的发病率都在增加。

为了评估美国妊娠期糖尿病患者不良妊娠结局的发生率是否随时间而变化，以及这些结局的风险是否因母亲种族和民族而异，研究组使用美国国家卫生统计中心1年内的出生率数据进行了一项探索性系列、横断面、描述性研究，涉及美国2014-2020年间1560822名年龄在15至44岁的妊娠期糖尿病、单胎非正常活产的患者。

根据出生证明上报告的分娩年份、种族和民族，将参与者分为非西班牙裔美洲印第安人、非西班牙裔亚洲/太平洋岛民、非西班牙裔黑人、西班牙裔/拉丁裔和非西班牙裔白人（对照组）。

主要产妇结局包括剖宫产、初次剖宫产、先兆子痫或妊娠期高血压、重症监护病房（ICU）入院和输血；新生儿结局包括胎龄较大（LGA）、巨大儿（出生时>4000克）、胎龄较小（SGA）、早产和新生儿重症监护室（NICU）入院，通过估计年平均百分比变化（APC）的频率（每1000活产）、差异比和校正的风险比来衡量。

1560822名患有妊娠期糖尿病的孕妇平均年龄为31岁，1%为美洲印第安人，13%为亚洲/太平洋岛民，12%为黑人，27%为西班牙裔/拉丁裔，48%为白人。2014-2020年，子痫前期或妊娠高血压（4.2%）、输血（8.0%）、37周以下早产（0.9%）和NICU入院（1.0%）的总频率（每年平均APC）显著增加。剖宫产分娩率（−1.4%）、初次剖宫产率（−1.2%）、LGA（−2.3%）和巨大儿率（−4.7%）显著降低。

产妇ICU入院和SGA率没有显著变化。与白人相比，除LGA和巨大儿外，黑人产妇在所有评估结果中的风险显著增加；除剖腹产和SGA外，美洲印第安产妇在所有评估结果中的风险显著增加；西班牙裔/拉丁裔和亚裔/太平洋岛民的产妇ICU入院、早产、NICU入院和SGA风险显著增加。这些年来，不同种族和民族的不良预后持续存在差异。

研究结果表明，2014-2020年，美国患有妊娠期糖尿病的孕妇出现多重不良妊娠结局的频率增加。按种族和民族划分的不良预后差异依然存在。

附：英文原文

Title: Risk of Adverse Pregnancy Outcomes Among Pregnant Individuals With Gestational Diabetes by Race and Ethnicity in the United States, 2014-2020

Author: Kartik K. Venkatesh, Courtney D. Lynch, Camille E. Powe, Maged M. Costantine, Stephen F. Thung, Steven G. Gabbe, William A. Grobman, Mark B. Landon

Issue&Volume: 2022/04/12

Abstract:

Importance  Gestational diabetes, which increases the risk of adverse pregnancy outcomes, has been increasing in frequency across all racial and ethnic subgroups in the US.

Objective  To assess whether the frequency of adverse pregnancy outcomes among those in the US with gestational diabetes changed over time and whether the risk of these outcomes differed by maternal race and ethnicity.

Design, Setting, and Participants  Exploratory serial, cross-sectional, descriptive study using US National Center for Health Statistics natality data for 1560822 individuals with gestational diabetes aged 15 to 44 years with singleton nonanomalous live births from 2014 to 2020 in the US.

Exposures  Year of delivery and race and ethnicity, as reported on the birth certificate, stratified as non-Hispanic American Indian, non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White (reference group).

Main Outcomes and Measures  Maternal outcomes of interest included cesarean delivery, primary cesarean delivery, preeclampsia or gestational hypertension, intensive care unit (ICU) admission, and transfusion; neonatal outcomes included large for gestational age (LGA), macrosomia (>4000 g at birth), small for gestational age (SGA), preterm birth, and neonatal ICU (NICU) admission, as measured by the frequency (per 1000 live births) with estimation of mean annual percentage change (APC), disparity ratios, and adjusted risk ratios.

Results  Of 1560822 included pregnant individuals with gestational diabetes (mean [SD] age, 31 [5.5] years), 1% were American Indian, 13% were Asian/Pacific Islander, 12% were Black, 27% were Hispanic/Latina, and 48% were White. From 2014 to 2020, there was a statistically significant increase in the overall frequency (mean APC per year) of preeclampsia or gestational hypertension (4.2% [95% CI, 3.3% to 5.2%]), transfusion (8.0% [95% CI, 3.8% to 12.4%]), preterm birth at less than 37 weeks (0.9% [95% CI, 0.3% to 1.5%]), and NICU admission (1.0% [95% CI, 0.3% to 1.7%]). There was a significant decrease in cesarean delivery (1.4% [95% CI, 1.7% to 1.1%]), primary cesarean delivery (1.2% [95% CI, 1.5% to 0.9%]), LGA (2.3% [95% CI, 2.8% to 1.8%]), and macrosomia (4.7% [95% CI, 5.3% to 4.0%]). There was no significant change in maternal ICU admission and SGA. In comparison with White individuals, Black individuals were at significantly increased risk of all assessed outcomes, except LGA and macrosomia; American Indian individuals were at significantly increased risk of all assessed outcomes except cesarean delivery and SGA; and Hispanic/Latina and Asian/Pacific Islander individuals were at significantly increased risk of maternal ICU admission, preterm birth, NICU admission, and SGA. Differences in adverse outcomes by race and ethnicity persisted through these years.

Conclusions and Relevance  From 2014 through 2020, the frequency of multiple adverse pregnancy outcomes in the US increased among pregnant individuals with gestational diabetes. Differences in adverse outcomes by race and ethnicity persisted.

DOI: 10.1001/jama.2022.3189

Source: https://jamanetwork.com/journals/jama/article-abstract/2790938

JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
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