Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort study.
Adult
Cross-Cultural Comparison
Diabetes, Gestational
/ epidemiology
Female
Health Surveys
Humans
Indians, North American
Infant
Infant Mortality
/ ethnology
Infant, Newborn
Perinatal Mortality
/ ethnology
Pregnancy
Pregnancy Outcome
/ ethnology
Pregnancy in Diabetics
/ epidemiology
Quebec
Risk
Stillbirth
/ ethnology
White People
first Nations
indigenous population
perinatal mortality
postneonatal mortality
pre-gestational diabetes
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
15 04 2019
15 04 2019
Historique:
entrez:
18
4
2019
pubmed:
18
4
2019
medline:
21
4
2020
Statut:
epublish
Résumé
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.
Identifiants
pubmed: 30992290
pii: bmjopen-2018-025084
doi: 10.1136/bmjopen-2018-025084
pmc: PMC6500205
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e025084Subventions
Organisme : CIHR
ID : 155955
Pays : Canada
Organisme : CIHR
ID : 106521
Pays : Canada
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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