A Population-Based Study of Diabetes during Pregnancy in Spain (2009–2015): Trends in Incidence, Obstetric Interventions, and Pregnancy Outcomes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design, Setting, and Participants
2.2. Main Outcomes Measures
2.3. Statistical Methods
2.4. Ethical Aspects
3. Results
3.1. Incidence of Deliveries, Obstetric Interventions and Obstetric Outcomes among Women with Existing and Gestational Diabetes
3.1.1. Time Trends in the Incidence and Demographic Characteristics of Deliveries in Women with Existing and Gestational Diabetes
3.1.2. Comorbidities and Obstetrical Risk Factors of Deliveries in Women with Existing and Gestational Diabetes
3.1.3. Impact of Diabetes Mellitus Types on Obstetrical Interventions and Maternal and Neonatal Health Outcomes
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | p | ||
---|---|---|---|---|---|---|---|---|---|
Without DM | N | 373,235 | 357,622 | 347,589 | 333,999 | 310,116 | 308,120 | 309,866 | |
Rate per 10,000 deliveries | 9522.2 | 9455.37 | 9443.42 | 9427.25 | 9384.65 | 9364.95 | 9405.12 | <0.001 | |
Maternal age, mean (SD) | 30.5 (5.56) | 30.68 (5.55) | 31 (5.51) | 31.17 (5.54) | 31.35 (5.56) | 31.49 (5.57) | 31.67 (5.6) | <0.001 | |
Type 1 DM | N | 705 | 771 | 789 | 859 | 811 | 865 | 761 | |
Rate per 10,000 deliveries | 17.98 | 20.38 | 21.43 | 24.24 | 24.54 | 26.29 | 23.09 | <0.001 | |
Maternal age, mean (SD) | 31.52 (5.03) | 31.7 (5.24) | 31.89 (5.19) | 31.81 (5.43) | 32.15 (5.13) | 32.32 (5.06) | 32.53 (5.2) | 0.001 | |
Type 2 DM | N | 571 | 545 | 591 | 586 | 668 | 692 | 738 | |
Rate per 10,000 deliveries | 14.56 | 14.41 | 16.05 | 16.54 | 20.21 | 21.03 | 22.4 | <0.001 | |
Maternal age, mean (SD) | 33.58 (5.78) | 33.9 (5.52) | 34.26 (5.28) | 34.38 (5.19) | 34.21 (5.62) | 34.22 (5.26) | 34.47 (5.3) | 0.073 | |
Gestational DM | N | 17,452 | 19,283 | 19,106 | 18,847 | 18,855 | 19,337 | 18,100 | |
Rate per 10,000 deliveries | 445.24 | 509.83 | 519.07 | 531.96 | 570.58 | 587.72 | 549.37 | <0.001 | |
Maternal age, mean (SD) | 33.19 (5.07) | 33.29 (5.01) | 33.46 (4.96) | 33.67 (4.99) | 33.88 (5.02) | 34.06 (4.95) | 34.16 (5.04) | <0.001 |
Without DM (n = 2,340,547) | Type 1 DM (n = 5561) | Type 2 DM (n = 4391) | Gestational DM (n = 130,980) | p | |
---|---|---|---|---|---|
Maternal age, mean (SD) | 31.1 (5.57) | 32 (5.19) | 34.17 (5.42) | 33.67 (5.02) | <0.001 |
15–24 years, n (%) | 313,139 (13.38) | 489 (8.79) | 174 (3.96) | 5784 (4.42) | <0.001 |
25–34 years, n (%) | 1,358,332 (58.03) | 3192 (57.4) | 2060 (46.91) | 65,494 (50) | <0.001 |
35–39 years, n (%) | 553,578 (23.65) | 1570 (28.23) | 1486 (33.84) | 44,693 (34.12) | <0.001 |
40–44 years, n (%) | 109,299 (4.67) | 297 (5.34) | 588 (13.39) | 13,843 (10.57) | <0.001 |
≥45 years, n (%) | 6199 (0.26) | 13 (0.23) | 83 (1.89) | 1166 (0.89) | 0.454 |
Pulmonary hypertension, n (%) | 112 (0) | <5 | <5 | 8 (0.01) | <0.001 |
Placenta previa, n (%) | 11,817 (0.5) | 35 (0.63) | 27 (0.61) | 822 (0.63) | <0.001 |
Sickle cell disease, n (%) | 7174 (0.31) | 28 (0.5) | 16 (0.36) | 485 (0.37) | <0.001 |
Gestational hypertension, n (%) | 24,462 (1.05) | 231 (4.15) | 144 (3.28) | 3221 (2.46) | <0.001 |
Mild preeclampsia or unspecified preeclampsia, n (%) | 21,877 (0.93) | 349 (6.28) | 198 (4.51) | 2431 (1.86) | <0.001 |
Severe preeclampsia/eclampsia, n (%) | 10,215 (0.44) | 123 (2.21) | 74 (1.69) | 851 (0.65) | <0.001 |
Chronic renal disease, n (%) | 4029 (0.17) | 161 (2.9) | 62 (1.41) | 268 (0.2) | <0.001 |
Preexisting hypertension, n (%) | 18,759 (0.8) | 268 (4.82) | 460 (10.48) | 3041 (2.32) | <0.001 |
Chronic ischemic heart disease, n (%) | 149 (0.01) | <5 | <5 | 16 (0.01) | <0.001 |
Congenital heart disease, n (%) | 1823 (0.08) | 12 (0.22) | <5 | 118 (0.09) | 0.001 |
Systemic lupus erythematosus, n (%) | 1822 (0.08) | 3 (0.05) | <5 | 81 (0.06) | 0.166 |
Human immunodeficiency virus, n (%) | 2043 (0.09) | <5 | 9 (0.2) | 104 (0.08) | 0.012 |
Multiple gestation, n (%) | 50,342 (2.15) | 101 (1.82) | 98 (2.23) | 4475 (3.42) | <0.001 |
Drug abuse, n (%) | 4468 (0.19) | 13 (0.23) | 6 (0.14) | 181 (0.14) | <0.001 |
Alcohol abuse, n (%) | 764 (0.03) | <5 | <5 | 31 (0.02) | 0.035 |
Tobacco use, n (%) | 114,001 (4.87) | 334 (6.01) | 249 (5.67) | 7466 (5.7) | <0.001 |
Cardiac valvular disease, n (%) | 2219 (0.09) | 5 (0.09) | 8 (0.18) | 160 (0.12) | 0.005 |
Chronic congestive heart failure, n (%) | <5 | <5 | <5 | <5 | 0.981 |
Asthma, n (%) | 35,711 (1.53) | 67 (1.2) | 99 (2.25) | 2319 (1.77) | <0.001 |
Obesity, n (%) | 38,657 (1.65) | 164 (2.95) | 474 (10.79) | 6896 (5.26) | <0.001 |
Previous cesarean delivery, n (%) | 192,441 (8.22) | 1033 (18.58) | 809 (18.42) | 15,144 (11.56) | <0.001 |
Obstetric Comorbidity Index | 978,769 (41.82) | 3306 (59.45) | 3079 (70.12) | 78,960 (60.28) | <0.001 |
Without DM | Type 1 DM | Type 2 DM | Gestational DM | |
---|---|---|---|---|
Labor induction. n (%) | 357,116 (15.26) | 1645 (29.58) | 1335 (30.4) | 29,535 (22.55) |
Crude RR (95% CI) | 1.94 (1.85–2.03) | 1.99 (1.89–2.10) | 1.48 (1.46–1.49) | |
Adjusted RR (95% CI) | 1.91 (1.82–2.00) | 1.94 (1.84–2.05) | 1.45 (1.44–1.47) | |
Cesarean delivery n (%) | 505,715 (21.61) | 3162 (56.86) | 2084 (47.46) | 37,828 (28.88) |
Crude RR (95% CI) | 2.63 (2.54–2.72) | 2.20 (2.10–2.29) | 1.34 (1.32–1.35) | |
Adjusted RR (95% CI) | 2.34 (2.26–2.43) | 1.83 (1.75–1.91) | 1.18 (1.17–1.20) | |
Forceps/vacuum extraction n (%) | 288,088 (12.31) | 650 (11.69) | 463 (10.54) | 15,523 (11.85) |
Crude RR (95% CI) | 0.94 (0.88–1.02) | 0.86 (0.78–0.94) | 0.96 (0.95–0.98) | |
Adjusted RR (95% CI) | 0.96 (0.89–1.04) | 0.88 (0.80–0.96) | 0.98 (0.96–0.99) | |
Episiotomy n (%) | 498,487 (21.3) | 690 (12.41) | 562 (12.8) | 25,113 (19.17) |
Crude RR (95% CI) | 0.58 (0.54–0.63) | 0.60 (0.55–0.65) | 0.90 (0.88–0.91) | |
Adjusted RR (95% CI) | 0.61 (0.57–0.66) | 0.65 (0.60–0.71) | 0.95 (0.94–0.96) | |
Severe Maternal morbidity n (%) | 32,744 (1.4) | 170 (3.06) | 90 (2.05) | 2103 (1.61) |
Crude RR (95% CI) | 2.18 (1.88–2.54) | 1.46 (1.19–1.80) | 1.15 (1.10–1.20) | |
Adjusted RR (95% CI) | 1.97 (1.70–2.29) | 1.25 (1.02–1.54) | 1.03 (0.99–1.08) | |
Prolonged maternal length of stay n (%) | 245,451 (10.49) | 1883 (33.86) | 1097 (24.98) | 14,662 (11.19) |
Crude RR (95% CI) | 3.22 (3.09–3.38) | 2.38 (2.24–2.53) | 1.07 (1.05–1.08) | |
Adjusted RR (95% CI) | 3.09 (2.95–3.23) | 2.22 (2.09–2.35) | 1.02 (0.99–1.03) | |
Preterm birth n (%) | 140,101 (5.99) | 1221 (21.96) | 660 (15.03) | 10,298 (7.86) |
Crude RR (95% CI) | 3.66 (3.47–3.88) | 2.51 (2.33–2.71) | 1.31 (1.29–1.34) | |
Adjusted RR (95% CI) | 3.32 (3.14–3.51) | 2.15 (1.99–2.32) | 1.18 (1.16–1.21) | |
Fetal overgrowth n (%) | 28,226 (1.21) | 572 (10.29) | 322 (7.33) | 4419 (3.37) |
Crude RR (95% CI) | 8.53 (7.85–9.26) | 6.08 (5.45–6.79) | 2.80 (2.71–2.89) | |
Adjusted RR (95% CI) | 8.05 (7.41–8.75) | 5.55 (4.97–6.20) | 2.63 (2.55–2.72) |
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López-de-Andrés, A.; Perez-Farinos, N.; Hernández-Barrera, V.; Palomar-Gallego, M.A.; Carabantes-Alarcón, D.; Zamorano-León, J.J.; De Miguel-Diez, J.; Jimenez-Garcia, R. A Population-Based Study of Diabetes during Pregnancy in Spain (2009–2015): Trends in Incidence, Obstetric Interventions, and Pregnancy Outcomes. J. Clin. Med. 2020, 9, 582. https://doi.org/10.3390/jcm9020582
López-de-Andrés A, Perez-Farinos N, Hernández-Barrera V, Palomar-Gallego MA, Carabantes-Alarcón D, Zamorano-León JJ, De Miguel-Diez J, Jimenez-Garcia R. A Population-Based Study of Diabetes during Pregnancy in Spain (2009–2015): Trends in Incidence, Obstetric Interventions, and Pregnancy Outcomes. Journal of Clinical Medicine. 2020; 9(2):582. https://doi.org/10.3390/jcm9020582
Chicago/Turabian StyleLópez-de-Andrés, Ana, Napoleón Perez-Farinos, Valentín Hernández-Barrera, María A. Palomar-Gallego, David Carabantes-Alarcón, José J. Zamorano-León, Javier De Miguel-Diez, and Rodrigo Jimenez-Garcia. 2020. "A Population-Based Study of Diabetes during Pregnancy in Spain (2009–2015): Trends in Incidence, Obstetric Interventions, and Pregnancy Outcomes" Journal of Clinical Medicine 9, no. 2: 582. https://doi.org/10.3390/jcm9020582