The prevalence of gestational diabetes mellitus before and after the implementation of the universal two-child policy in China

BACKGROUND: After the universal two-child policy has been fully implemented, challenges regarding pregnancy complications seemed to be more severe in China. This study aimed to evaluate the prevalence of gestational diabetes mellitus (GDM) and the main risk factors for GDM before and after the implementation of the universal two-child policy in China. METHODS: A retrospective study was performed with 128,270 pregnant women who delivered at Ningbo Women & Children’s Hospital from January 2010 to December 2020. Univariate and multivariate logistic regression analysis was applied to estimate the risk factors associated with GDM prevalence. Segmented regression analyses of interrupted time series (ITS) were conducted to assess the effect of the universal two-child policy on the trends of GDM. RESULTS: The prevalence of GDM increased remarkably from 4% in 2010 to 21% in 2020. ITS analysis presented that the prevalence of GDM increased by 0.190% (β1) per month from 2010 to 2016 (P<0.05), and by 0.044% (β1+β3) per month after the implementation of the universal two-child policy; the rate of elevation of GDM slowed down significantly (β3=-0.146, P=0.004). Advanced maternal age (>30 years), multigravidity, multiparity, multiple gestation and gestational hypertension were significantly associated with GDM. Advanced age remained an independent risk factor for GDM even after cross stratification with gravidity and parity. The proportion of women with advanced maternal age (>30 years) increased by 0.161% per month before the implementation of the universal two-child policy and increased by 5.25% during the policy took effect month, and gradually increased by 0.124% (β1+β3) per month after then. CONCLUSIONS: The prevalence of GDM has sharply increased in the past decade. The growth rate of GDM slowed down after the implementation of the universal two-child policy in China, but the rate would maintain at a high plateau. The rise in the proportion of older pregnant women could increase the GDM rate. We recommend having children at a relatively optimal reproductive age when encouraging childbearing.