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
Objective 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 dif...
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BMJ Publishing Group
2019-04-01
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| Series: | BMJ Open |
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| author | Lu Chen Nathalie Auger Wen-Juan Wang Lin Xiao Jill Torrie Nancy Gros-Louis McHugh Zhong-Cheng Luo |
| author_facet | Lu Chen Nathalie Auger Wen-Juan Wang Lin Xiao Jill Torrie Nancy Gros-Louis McHugh Zhong-Cheng Luo |
| author_sort | Lu Chen |
| collection | DOAJ |
| description | Objective 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.Design A population-based linked birth cohort study.Setting and participants 17 090 First Nations and 217 760 non-Indigenous singleton births in 1996–2010, Quebec, Canada.Main outcome measures 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.Results 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.Conclusions 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. |
| format | Article |
| id | doaj-art-db538a5e922e40b8a63cab7353a49f18 |
| institution | OA Journals |
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| language | English |
| publishDate | 2019-04-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-db538a5e922e40b8a63cab7353a49f182025-08-20T01:48:57ZengBMJ Publishing GroupBMJ Open2044-60552019-04-019410.1136/bmjopen-2018-025084Diabetes in pregnancy in associations with perinatal and postneonatal mortality in First Nations and non-Indigenous populations in Quebec, Canada: population-based linked birth cohort studyLu Chen0Nathalie Auger1Wen-Juan Wang2Lin Xiao3Jill Torrie4Nancy Gros-Louis McHugh5Zhong-Cheng Luo62 Department of Neurology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing 100191, ChinaUniversity of Montreal Hospital Centre Research Centre, Montreal, Québec, CanadaMinistry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai Jiaotong University School of Medicine, Xinhua Hospital, Shanghai, China2 Chinese Center for Disease Control and Prevention, Beijing, ChinaPublic-Health Department, Cree Board of Health and Social Services of James Bay, Mistissini, Quebec, CanadaFirst Nations of Quebec and Labrador Health and Social Service Commission, Wendake, Quebec, CanadaDepartment of Obstetrics and Gynecology, Lunenfeld-Tanenbaum Research Institute, Prosserman Population Health Center, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, Dalla Luna School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, CanadaObjective 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.Design A population-based linked birth cohort study.Setting and participants 17 090 First Nations and 217 760 non-Indigenous singleton births in 1996–2010, Quebec, Canada.Main outcome measures 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.Results 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.Conclusions 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.https://bmjopen.bmj.com/content/9/4/e025084.full |
| spellingShingle | Lu Chen Nathalie Auger Wen-Juan Wang Lin Xiao Jill Torrie Nancy Gros-Louis McHugh Zhong-Cheng Luo 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 BMJ Open |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://bmjopen.bmj.com/content/9/4/e025084.full |
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