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Prevalence of Pre-Pregnancy Diabetes, Obesity, and Hypertension in Canada

Published:March 23, 2019DOI:https://doi.org/10.1016/j.jogc.2019.01.020

      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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      REFERENCES

        • Kapur A
        Links between maternal health and NCDs.
        Best Pract Res Clin Obstet Gynaecol. 2015; 29: 32-42
        • HAP Study Cooperative Research Group
        The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study.
        Int J Gynaecol Obstet. 2002; 78: 69-77
        • Poston L
        • Caleyachetty R
        • Cnattingius S
        • et al.
        Preconceptional and maternal obesity: epidemiology and health consequences.
        Lancet Diabetes Endocrinol. 2016; 4: 1025-1036
        • Macintosh MC
        • Fleming KM
        • Bailey JA
        • et al.
        Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study.
        BMJ. 2006; 333: 177
        • Koyanagi A
        • Zhang J
        • Dagvadorj A
        • et al.
        Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey.
        Lancet. 2013; 381: 476-483
        • Bartsch E
        • Medcalf KE
        • Park AL
        • et al.
        Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies.
        BMJ. 2016; 353: i1753
        • Roberts CL
        • Bell JC
        • Ford JB
        • et al.
        The accuracy of reporting of the hypertensive disorders of pregnancy in population health data.
        Hypertens Pregnancy. 2008; 27: 285-297
        • Fong A
        • Serra A
        • Herrero T
        • et al.
        Pre-gestational versus gestational diabetes: a population based study on clinical and demographic differences.
        J Diabetes Complications. 2014; 28: 29-34
        • Ogden CL
        • Carroll MD
        • Kit BK
        • et al.
        Prevalence of childhood and adult obesity in the United States, 2011-2012.
        JAMA. 2014; 311: 806-814
        • Keating C
        • Backholer K
        • Gearon E
        • et al.
        Prevalence of class-I, class-II and class-III obesity in Australian adults between 1995 and 2011–12.
        Obes Res Clin Pract. 2015; 9: 553-562
        • Bateman BT
        • Bansil P
        • Hernandez-Diaz S
        • et al.
        Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions.
        Am J Obstet Gynecol. 2012; 206: 134
        • Feig DS
        • Hwee J
        • Shah BR
        • et al.
        Trends in incidence of diabetes in pregnancy and serious perinatal outcomes: a large, population-based study in Ontario, Canada, 1996–2010.
        Diabetes Care. 2014; 37: 1590-1596
        • Opray N
        • Grivell RM
        • Deussen AR
        • et al.
        Directed preconception health programs and interventions for improving pregnancy outcomes for women who are overweight or obese.
        Cochrane Database Syst Rev. 2015; CD010932
      1. Statistics Canada. Table 051-0001 - Estimates of Population, by Age Group and Sex for July 1, Canada, Provinces and Territories, Annual (Persons Unless Otherwise Noted). CANSIM (database). https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501.

        • Fell DB
        • Sprague AE
        • Liu N
        • et al.
        H1N1 influenza vaccination during pregnancy and fetal and neonatal outcomes.
        Am J Public Health. 2012; 102: e33-e40
        • Better Outcomes Registry & Network (BORN) Ontario
        Annual report 2012–2013 and 2013–2014.
        BORN Ontario, Ottawa2015
        • Yaktine AL
        • Rasmussen KM
        Weight gain during pregnancy: reexamining the guidelines.
        National Academies Press, Washington, DC2009
        • White IR
        • Royston P
        • Wood AM
        Multiple imputation using chained equations: issues and guidance for practice.
        Stat Med. 2011; 30: 377-399
        • Fay MP
        • Feuer EJ.
        Confidence intervals for directly standardized rates: a method based on the gamma distribution.
        Stat Med. 1997; 16: 791-801
        • WHO Expert Consultation
        Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.
        Lancet. 2004; 363: 157
        • Flegal KM
        • Kruszon-Moran D
        • Carroll MD
        • et al.
        Trends in obesity among adults in the United States, 2005 to 2014.
        JAMA. 2016; 315: 2284-2291
        • Melesse DY
        • Halli SS
        • Tate RB
        Variations over four decades in body mass index trajectories prior to diagnosis of diabetes mellitus: the Manitoba Follow-up Study, 1948–2007.
        Can J Public Health. 2015; 106: 95-100
        • Kim SA
        • Yount KM
        • Ramakrishnan U
        • et al.
        The relationship between parity and overweight varies with household wealth and national development.
        Int J Epidemiol. 2006; 36: 93-101
        • Twells LK
        • Gregory DM
        • Reddigan J
        • et al.
        Current and predicted prevalence of obesity in Canada: a trend analysis.
        CMAJ Open. 2014; 2: E18
        • Albrecht SS
        • Kuklina EV
        • Bansil P
        • et al.
        Diabetes trends among delivery hospitalizations in the US, 1994–2004.
        Diabetes Care. 2010; 33: 768-773
        • Kanguru L
        • Bezawada N
        • Hussein J
        • et al.
        The burden of diabetes mellitus during pregnancy in low-and middle-income countries: a systematic review.
        Glob Health Action. 2014; 7: 23987
        • Kenny LC
        • Lavender T
        • McNamee R
        • et al.
        Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort.
        PloS One. 2013; 8: e56583
        • Vladutiu CJ
        • Siega-Riz AM
        • Sotres-Alvarez D
        • et al.
        Parity and components of the metabolic syndrome among US Hispanic/Latina women.
        Circ Cardiovasc Qual Outcomes. 2016; 9: S62-S69
        • Johnson J-A
        • Tough S
        • Wilson RD
        • et al.
        Delayed child-bearing.
        J Obstet Gynaecol Can. 2012; 34: 80-93
        • Health Quality Ontario
        In vitro fertilization and multiple pregnancies: an evidence-based analysis.
        Ontario Health Techn Assess Ser. 2006; 6: 1-63
        • Lanes A.
        IVF funding in Ontario: how do we define success?.
        in: Lecture presented at: Better Outcomes Registry and Network Annual Conference, Toronto, ON2017
        • Grobman WA
        • Parker CB
        • Willinger M
        • et al.
        Racial disparities in adverse pregnancy outcomes and psychosocial stress.
        Obstet Gynecol. 2018; 131: 328-335
        • Maskarinec G
        • Grandinetti A
        • Matsuura G
        • et al.
        Diabetes prevalence and body mass index differ by ethnicity: the Multiethnic Cohort.
        Ethn Dis. 2009; 19: 49-55
        • Raji A
        • Seely EW
        • Arky RA
        • et al.
        Body fat distribution and insulin resistance in healthy Asian Indians and Caucasians.
        J Clin Endocrinol Metab. 2001; 86: 5366-5371