孕前和妊娠期糖尿病（PGDM，GDM）在原住民（北美印第安人）孕妇中的发生率高于加拿大的非土著孕妇。我们评估了PGDM和GDM对围产期和新生儿后死亡率的影响在第一民族与非土著人群中是否不同。
一项基于人群的出生关联队列研究。
1996-2010年，魁北克有17090个第一民族和217760个非土著单胎出生，加拿大。
围产期和新生儿死亡的相对风险（RR）。围产期死亡包括死产和新生儿（产后0-27天）死亡；新生儿后死亡包括28-364天的婴儿死亡。
PGDM和GDM在原住民中的发生率更高（3.9％和10.7％，分别）与非土著（1.1%和4.8%，分别)孕妇。在第一民族中，PGDM与围产期死亡风险增加的程度更大（RR=5.08[95％CI2.99至8.62]，p<0.001；绝对风险（AR）=21.6[8.6-34.6]/1000）与非土著人口（RR=1.76[1.17,2.66]，p=0.003;AR=4.2[0.2,8.1]/1000)。PGDM与非土著新生儿死亡风险增加相关(RR=3.46[1.71,6.99],p<0.001；AR=2.4[0.1，4.8]/1000），但不是第一民族（RR=1.16[0.28，4.77]，p=0.35）婴儿。调整孕产妇和妊娠特征，协会是相似的。两组GDM均与围产期或新生儿死亡无关。
这项研究首次揭示，与非土著居民相比，PGDM可能会在更大程度上增加原住民的围产期死亡风险。但可能会大大增加非土著婴儿新生儿后死亡的风险。根本原因尚不清楚，值得进一步研究。我们推测，糖尿病妊娠中血糖控制质量的人群差异和/或高血糖症胎儿毒性的遗传易感性可能是促成因素。
Both pregestational and gestational diabetes mellitus (PGDM, GDM) occur more frequently in First Nations (North American Indians) pregnant women than their non-Indigenous counterparts in Canada. We assessed whether the impacts of PGDM and GDM on perinatal and postneonatal mortality may differ in First Nations versus non-Indigenous populations.
A population-based linked birth cohort study.
17 090 First Nations and 217 760 non-Indigenous singleton births in 1996-2010, Quebec, Canada.
Relative risks (RR) of perinatal and postneonatal death. Perinatal deaths included stillbirths and neonatal (0-27 days of postnatal life) deaths; postneonatal deaths included infant deaths during 28-364 days of life.
PGDM and GDM occurred much more frequently in First Nations (3.9% and 10.7%, respectively) versus non-Indigenous (1.1% and 4.8%, respectively) pregnant women. PGDM was associated with an increased risk of perinatal death to a much greater extent in First Nations (RR=5.08[95% CI 2.99 to 8.62], p<0.001; absolute risk (AR)=21.6 [8.6-34.6] per 1000) than in non-Indigenous populations (RR=1.76[1.17, 2.66], p=0.003; AR=4.2[0.2, 8.1] per 1000). PGDM was associated with an increased risk of postneonatal death in non-Indigenous (RR=3.46[1.71, 6.99], p<0.001; AR=2.4[0.1, 4.8] per 1000) but not First Nations (RR=1.16[0.28, 4.77], p=0.35) infants. Adjusting for maternal and pregnancy characteristics, the associations were similar. GDM was not associated with perinatal or postneonatal death in both groups.
The study is the first to reveal that PGDM may increase the risk of perinatal death to a much greater extent in First Nations versus non-Indigenous populations, but may substantially increase the risk of postneonatal death in non-Indigenous infants only. The underlying causes are unclear and deserve further studies. We speculate that population differences in the quality of glycaemic control in diabetic pregnancies and/or genetic vulnerability to hyperglycaemia\'s fetal toxicity may be contributing factors.
PDF(Sci-hub)