Abstract
Objective
Pre-existing diabetes mellitus (D), obesity (O), and chronic hypertension (H) can
each alter the natural course of pregnancy, especially when they cluster together.
Because the prevalence of various combinations of D, O, and H is unknown, the current
study was undertaken.
Methods
This population-based cross-sectional study included 506 483 singleton and twin live
birth and stillbirth deliveries in Ontario, occurring at ≥20 weeks gestation. All
hospital births from 2012 to 2016 were identified in the Better Outcomes Registry
and Network information system. The prevalence per 1000 births (95% confidence interval
[CI]) of D, O, and H and their combinations were calculated. Prevalence estimates
were stratified by twin and singleton gestations, maternal age, parity, and ethnicity
(Canadian Task Force Classification II-2).
Results
During the study period, 5493 women (10.8 per 1000 births; 95% CI 10.6–11.1) had D,
90,177 (178.2; 95% CI 177.0–179.3) had O, and 5667 (11.2; 95% CI 10.9–11.5) had H.
The prevalence per 1000 of DO was 4.8, DH 1.0, and OH 5.5, whereas 359 women (0.71
per 1000) had all three. D and H each linearly increased with rising maternal age,
along with their combinations, and to some degree with higher parity. The combination
of O and H was highest among women of Black ancestry (14.5 per 1000) and lowest among
those of Asian ancestry (3.0 per 1000).
Conclusion
D, O, and H are common conditions in pregnancy, both alone and in various combinations.
These data can be used to assess the impact of each state on perinatal health.
Résumé
Objectif
Lorsqu'ils sont présents avant la grossesse, le diabète (D), l'obésité (O) et l'hypertension
chronique (H) peuvent en modifier la progression naturelle, surtout s'ils sont présents
simultanément. La présente étude a été entreprise pour déterminer la prévalence des
diverses combinaisons de D, O et H, actuellement inconnue.
Méthodologie
Cette étude transversale fondée sur la population portait sur 506 483 accouchements
s'étant soldés par une naissance vivante ou une mortinaissance d'un seul bébé ou de
jumeaux en Ontario, survenus après au moins 20 semaines de gestation. Des données
sur toutes les naissances survenues en hôpital de 2012 à 2016 ont été extraites du
Registre et réseau des bons résultats dès la naissance. Les prévalences pour 1 000
accouchements (intervalle de confiance [IC] à 95 %) de D, O et H et de leurs combinaisons
ont été calculées. Les estimations de la prévalence ont été stratifiées selon le type
de grossesse (monofœtale ou gémellaire), l'âge de la mère, la parité et l'origine
ethnique (classification II-2 du Groupe d'étude canadien).
Résultats
Durant la période à l'étude, nous avons recensé 5 493 femmes enceintes atteintes de
diabète (10,8 pour 1 000 accouchements; IC à 95 % : 10,6–11,1), 90 177, d'obésité
(178,2; IC à 95 % : 177,0–179,3), et 5 667, d'hypertension chronique (11,2; IC à 95 %
: 10,9–11,5). La prévalence pour 1 000 accouchements était de 4,8 pour la combinaison
DO, de 1,0 pour DH et de 5,5 pour OH; 359 femmes présentaient les trois affections
simultanément (0,71 pour 1 000 accouchements). La prévalence du diabète et de l'hypertension
chronique, seuls ou en combinaison, augmentait de façon linéaire avec l'âge maternel,
ainsi qu'avec la parité (dans une certaine mesure). La prévalence de la combinaison
OH était à son maximum chez les femmes d'ascendance noire (14,5 pour 1000) et à son
minimum chez celles d'ascendance asiatique (3,0 pour 1000).
Conclusion
Le diabète, l'obésité et l'hypertension chronique sont des affections communément
observées chez les femmes enceintes, seules ou en combinaison. Les données recueillies
ici pourront servir à déterminer l'incidence de chacune sur la santé périnatale.
Key Words
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Article info
Publication history
Published online: March 23, 2019
Footnotes
Competing interests: See Acknowledgements.
Each author has indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
