Introduction The incidence of gestational diabetes mellitus (GDM) is increasing in Australia, influenced by changed diagnostic criteria. We aimed to identify whether the diagnostic change was associated with improved outcomes and/or increased obstetric interventions using state-wide data in New South Wales (NSW), Australia. Research design and methods Perinatal and hospital data were linked for singleton births, 33–41 weeks’ gestation, 2006–2015, NSW. An adjusted Poisson model was used to split pregnancies from 2011 onwards into those that would have been diagnosed under the old criteria (‘previous GDM’) and newly diagnosed cases (‘additional GDM’). We compared actual rates of total and early (<39 weeks) planned births, cesareans, and maternal and neonatal adverse outcomes for GDM-diagnosed pregnancies using three predicted scenarios, where the ‘additional GDM’ group was assumed to have the same rates as: the ‘previous GDM’ group <2011 (scenario A); the ‘non-GDM’ group <2011 (scenario B); or the ‘non-GDM’ group ≥2011 (scenario C). Results GDM incidence more than doubled over the study period, with an inflection point observed at 2011. For those diagnosed with GDM since 2011, the actual incidence of interventions (planned births and cesareans) and macrosomia was consistent with scenario A, which meant higher intervention rates, but lower rates of macrosomia, than those with no GDM. Incidence of neonatal hypoglycemia was lower than scenario A and closer to the other scenarios. There was a reduction in perinatal deaths among those with GDM, lower than that predicted by all scenarios, indicating an improvement for all with GDM, not only women newly diagnosed. Incidence of maternal and neonatal morbidity indicators was within the confidence bounds for all three predicted scenarios. Conclusions Our study suggests that the widely adopted new diagnostic criteria for GDM are associated with increased obstetric intervention rates and lower rates of macrosomic babies, but with no clear impacts on maternal or neonatal morbidity. Data may be obtained from a third party and are not publicly available. The data that support the findings of this study are available from the NSW Ministry of Health but restrictions apply to the availability of these data, which were used under license for the current study, and are not publicly available. The data sets were constructed with the permission of each of the source data custodians and with specific ethical approval from the NSW Population and Health Services Research Ethics Committee (reference number 2012/12/430). The data were linked by the Centre for Health Record Linkage (cherel.org.au).

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澳大利亚新南威尔士州新引入的妊娠糖尿病诊断标准是否与改善妊娠结局和/或增加干预措施有关？基于人群的数据关联研究

简介 受诊断标准改变的影响，澳大利亚的妊娠期糖尿病 (GDM) 的发病率正在增加。我们旨在使用澳大利亚新南威尔士州 (NSW) 的全州数据来确定诊断变化是否与改善的结果和/或增加的产科干预有关。研究设计和方法 2006 年至 2015 年，新南威尔士州，围产期和医院的数据与孕 33 至 41 周的单胎分娩相关联。使用调整后的泊松模型将 2011 年以后的妊娠分为根据旧标准诊断的妊娠（“先前 GDM”）和新诊断的病例（“附加 GDM”）。我们使用三种预测情景比较了 GDM 诊断妊娠的总体和早期（<39 周）计划生育、剖宫产以及孕产妇和新生儿不良结局的实际发生率，其中“附加 GDM”组被假定为与以下相同的比率：“先前 GDM”组 <2011（情景 A）；“非 GDM”组 <2011（场景 B）；或“非 GDM”组≥2011（情景 C）。结果 GDM 发病率在研究期间翻了一番多，在 2011 年观察到了一个拐点。 对于自 2011 年以来被诊断为 GDM 的那些，干预（计划生育和剖宫产）和巨大儿的实际发生率与情景 A 一致，这意味着更高的干预率，但与没有 GDM 的人相比，巨大儿的发生率更低。新生儿低血糖的发生率低于情景 A，更接近于其他情景。GDM 患者围产期死亡人数下降，低于所有情景的预测，表明所有 GDM 患者都有改善，而不仅仅是新诊断的女性。孕产妇和新生儿发病率指标的发生率在所有三种预测情景的置信范围内。结论 我们的研究表明，广泛采用的 GDM 新诊断标准与产科干预率增加和巨大婴儿发生率降低有关，但对孕产妇或新生儿发病率没有明显影响。数据可能从第三方获得并且不公开可用。支持本研究结果的数据可从新南威尔士州卫生部获得，但这些数据的可用性受到限制，这些数据是在当前研究的许可下使用的，并且不公开可用。数据集是在每个源数据保管人的许可下构建的，并获得了新南威尔士州人口与健康服务研究伦理委员会的特定伦理批准（参考编号 2012/12/430）。这些数据由健康记录链接中心 (cherel.org.au) 链接。