Background
Methods
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To study the pooled prevalence of GDM among general population of pregnant women;
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To study the pooled prevalence of pregnant women based on the various diagnostic criteria of blood glucose;
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To study the pooled prevalence of pregnant women based on various GDM screening criteria groups of pregnant women in different geographic regions;
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To study the association between prevalence of GDM and its diagnostic criteria regardless of the geographic region.
Search strategy
Selection criteria, study selection and data extraction
Study subgroups
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Group 1 or IADPSG definition, screened based on OGTT with 75 g 2-h. Threshold: one value > 92, 180 and 153 mg/dL for fasting, 1, 2 and 3 h;
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Group 2, screened based on OGTT with 75 g 2-h. Threshold: one value > 100 and 144 mg/dL for fasting and 2 h;
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Group 3, screened based on OGTT with 75 g 2-h. Threshold: one value > 110 and 140 mg/dL for fasting, 1 and 2 h;
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Group 4, screened based on OGTT with 75 g 2-h. Threshold: value > 180 mg/dL for 2 h.
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Group 5, screened based on GCT with 50 g 1-h GCT, Threshold: values > 140 mg/dL following OGTT with 100 g 3-h. Threshold: two value > 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h or GCT with 50 g 1-h GCT, Threshold: values > 140 mg/dL following OGTT with 75 g 3-h. Threshold: two values > 95, 180, 155 and 140 mmol/L for fasting, 1, 2 and 3 h;
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Group 6, screened based on Glucose challenge test (GCT) with 50 g 1-h, Threshold: 140 mg/dL following oral glucose tolerance test (OGTT) with 100 g 3-h. Threshold: two values > 105 or 190, 155, 165 and 145 mg/dL for fasting, 1, 2 and 3 h;
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Group 7, screened based on OGTT with 100 g 3-h. Threshold: one value > 120, 175, 155 and 140 mg/dL for fasting, 1, 2 and 3 h.
Quality assessment and risk of bias
Statistical analysis
Results
Search results, study selection, study characteristics, and quality assessment
Author, year | Country | Type of GDM screening test | GDM criteria | Year of sampling | Sample size | Prevalence of GDM | Quality scaling |
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Aljohani et al. 2008a | Canada | GCT with 50 g 1-h GCT, threshold: values above 7.8 mmol/L following OGTT with 100 g 3-h. Threshold: two value above 5.8, 10.6, 9.2 and 8.1 mmol/L for fasting, 1, 2 and 3 h | National criteria | 1985–2004 | 324,605 | 2.9 | Moderate |
Al Mahroos et al. 2005a | Bahrain | GCT with 50 g 1-h GCT, threshold: values above 140 mg/dL following OGTT with 75 g 3-h. Threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h | Fourth international conference on GDM | 2001–2002 | 10,495 | 13.3 | High |
Anna et al. 2008b | Australia | GCT with 50 g 1-h GCT, threshold: values above 7.8 mmol/L following OGTT with 75 g glucose. Threshold: value above 5.5, 8 mmol/L for fasting and 2 h | National criteria | 1995–2005 | 950,737 | 3.7 | High |
Arora et al. 2015b | India | 1. OGTT with 75 g glucose. Threshold: value above 5.1 and 8.5 mmol/L for fasting and 2 h 2. OGTT with 75 g glucose. Threshold: value above 7 and 7.8 mmol/L for fasting and 2 h | 1. WHO 2013 2. WHO 1999 | 2009–2012 | 1. 5100 2. 5100 | 1. 34.9 2. 9 | Moderate |
Baptiste-Roberts et al. 2012a | USA | OGTT with 100 g 3-h. Threshold: value above 120 or 175, 155 and 140 mg/dL for fasting and 1 h, and did not return to normal in the 2- and 3-h | National criteria | 1959–1966 | 28,358 | 1.7 | High |
Leng et al. 2015a | China | 1. GCT with 50 g 1-h GCT, Threshold: values above 7.8 mmol/L following OGTT with 75 g 2-h. Threshold: one value above 5.1, 10.0 and 8.5 mg/dL for fasting, 1 and 2 h 2. GCT with 50 g 1-h GCT, Threshold: values above 7.8 mmol/L following OGTT with 75 g 2-h. Threshold: Fasting < 7.0 mmol/L and 2-h > 7.8 but < 11.1 mmol/L OR fasting > 6.1 but < 7.0 mmol/L and 2-h PG < 7.8 mmol/L | 1. IADPSG 2. WHO1999 | 2010–2012 | 1. 17,808 2. 17,808 | 1. 7.7 2. 6.8 | High |
Chodick et al. 2010a | Israel | GCT with 50 g 1-h GCT, threshold: not mentioned, following OGTT with 100 g 3-h. Threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h | Carpenter and Coustan | 1995–1999 | 185,416 | 6.07 | High |
Moses et al. 2011a | Australia | 1. OGTT with 75 g glucose. Threshold: one value above or equal to 5.5 and 8.0 mmol/L for fasting and 2 h 2. OGTT with (not mentioned) g glucose. Threshold: one value above or equal to 5.1, 10.0 and 8.2 mmol/L for fasting, 1 and 2 h | 1. ADIPS 2. IADPSG | NM* | 1. 1275 2. 1275 | 1. 9.6 2. 13 | Moderate |
Erjavec et al. 2016b | Croatia | 1. OGTT with 75 g glucose. Threshold: one value above or equal to 6.1 and 7.8 mmol/L for fasting and 2 h 2. OGTT with 75 g glucose. Threshold: one value above or equal to 5.1, 10.0 and 8.5 mmol/L for fasting, 1 and 2 h | 1. WHO 1999 2. National criteria | 1. 2010 2. 2014 | 1. 42,656 2. 39,092 | 1. 2.2 2. 4.7 | High |
Ferrara et al. 2004a | USA | 1. GCT with 50 g 1-h, threshold: not mentioned, following OGTT with 100 g 3-h. Threshold: Two value above 95 or 180, 155 and 140 mg/dL for fasting, 1 and 2 h 2. 2 hpp > 200 mg/dL, 3. FBS > 126 mg/dL, 4. OGTT with 75 g 2-h, threshold: value above 140 mg/dL for 2 h, 5. GDM histort at time of hospital discharge | ADA, ACOG and WHO | 1999–2000 | 267,051 | 6.33 | Moderate |
Ferrara et al. 2002b | USA | 1. GCT with 50 g 1-h, threshold: 140 mg/dL following OGTT with 100 g 3-h. Threshold: two value above 105 or 190, 155, 165 and 145 mg/dL for fasting, 1, 2 and 3 h 2. GCT with 50 g 1-h, threshold: 140 mg/dL following OGTT with 100 g 3-h. Threshold: Two value above 95 or 180, 155, 140 and 145 mg/dL for fasting, 1, 2 and 3 h | 1. NDDG 2. Carpenter and Coustan | 1996 | 1. 26,481 2. 26,481 | 1. 3.2 2. 4.8 | High |
Gao et al. 2010b | China | (1) GCT with 50 g 1-h, Threshold: ≥ 7.8 mmol/L but < 11.1 mmol/L, (2) FPG ≥ 5.8 mmol/L, (3) Random FPG ≥ 5.8 mmol/L twice, following OGTT with 75 g 3-h. Threshold: two value above 5.3, 10.0, 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h | ADA | 2006 | 4179 | 17.9 | Moderate |
Hedderson et al. 2010a | USA | GCT with 50 g 1-h, threshold: not mentioned following OGTT with 100 g 3-h, threshold: two value above 95 or 180, 155, 140 and 145 mg/dL for fasting, 1, 2 and 3 h | ADA | 1995–2004 | 216,089 | 5.8 | High |
Ignell et al. 2014b | Sweden | OGTT with 75 g glucose. Threshold: value above or equal 10.0 mmol/L for 2 h | European Association of the Study of Diabetes | 2003–2012 | 156,144 | 2.2 | Moderate |
Jenum et al. 2012a | Norway | 1. OGTT with 75 g glucose. Threshold: one value above or equal to 7 and 7.8 mmol/L for fasting and 2 h 2. OGTT with 75 g glucose. Threshold: one value above or equal to 5.1 and 8.5 mmol/L for fasting and 2 h | 1. WHO 2. IADPSG | 2008–2010 | 1. 759 2. 759 | 1. 13 2. 31.5 | High |
Ishak et al. 2003a | Australia | OGTT with 75 g glucose. Threshold: one value above or equal to 5.5 and 8 mmol/L for fasting and 2 h OR OGTT with 75 g glucose. Threshold: one value above or equal to 7.8 and 11 mmol/L for fasting and 2 h | National criteria | 1988–1999 | 230,011 | 2.46 | Moderate |
Janghorbani et al. 2006a | UK | Random plasma glucose, threshold: 6.5 mmol/L following OGTT with 75 g glucose. Threshold: one value above or equal to 6 and 7.5 mmol/L for fasting and 2 h | WHO | 1996–1997 | 4942 | 1.8 | Moderate |
Jesmin et al. 2014b | Bangladesh | 1. GCT with 50 g 1-h, threshold: 7.8 mmol/L following OGTT with 75 g 2-h, threshold: ne value above or equal to 7 and 7.8 mmol/L for fasting and 2 h 2. GCT with 50 g 1-h, threshold: 7.8 mmol/L following OGTT with 75 g 2-h, threshold: ne value above or equal to 5.3 and 8.6 mmol/L for fasting and 2 h | 1. WHO 2. ADA | 2012–2013 | 1. 3447 2. 3447 | 1. 9.7 2. 12.9 | Moderate |
Kalamegham et al. 2010a | USA | GCT with 50 g 1-h, threshold: 130 mg/dL following OGTT with 100 g 3-h, threshold: ne value above or equal to 7 and 7.8 mmol/L for fasting and 2 h | ADA | 2000–2007 | 18,307 | 8.6 | Moderate |
Lawrence et al. 2008a | USA | GCT with 50 g 1-h, threshold: not mentioned following (1) OGTT with 100 g 3-h, threshold: two value above or equal to 5.3, 10, 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h OR (2) OGTT with 75 g glucose, threshold: two value above or equal to 5.3, 10 and 8.6 for fasting, 1 and 2 h OR (3) FBS ≥ 7 mmol/L OR (4) random plasma glucose ≥ 11.1 mmol/L | ADA | 1999–2005 | 199,298 | 7.6 | High |
Leng et al. 2016a | China | GCT with 50 g 1-h, threshold: ≥ 7.8 mmol/L following OGTT with 75 g 2-h, threshold: value above 5.1, 10.0 and 8.5 mmol/L for fasting, 1 and 2 h | IADPSG | 2010–2012 | 11,450 | 7.3 | High |
Magee et al. 1993a | USA | 1. GCT with 50 g 1-h, threshold: ≥ 7.7 mmol/L following OGTT with 100 g 3-h, threshold: two value above 5.9, 10.6, 9.2 and 8.1 mmol/L for fasting, 1, 2 and 3 h 2. GCT with 50 g 1-h, threshold: ≥ 7.7 mmol/L following OGTT with 100 g 3-h, threshold: two value above 5.3, 10.1, 8.7 and 7.8 mmol/L for fasting, 1, 2 and 3 h | 1. NDDG 2. Modified NDDG | 1985–1986 | 1. 2019 2. 2019 | 1. 1.6 2. 5.8 | High |
McCarth et al. 2010a | Argentina | OGTT with 75 g glucose. Threshold: value above or equal to 7.8 mmol/L for 2 h | National criteria | NM* | 1702 | 5.8 | Moderate |
Melchior et al. 2017b | Germany | GCT with 50 g 1-h, threshold: ≥ 135 and ≤ 200 mg/dL following OGTT with 75 g 2-h, threshold: value above 92, 180 and 153 mg/dL for fasting, 1 and 2 h | ICD-10 | 2014–2015 | 458,291 | 13.2 | Moderate |
Mizuno et al. 2016b | Japan | Random blood glucose, threshold: > 100 mg/dL following OGTT with 75 g 2-h, threshold: value above or equal to 92, 180 and 153 mg/dL for fasting, 1 and 2 h | National criteria | 2011 | 8874 | 2.3 | High |
Murphy et al. 1993a | USA | GCT with 50 g 1-h, threshold: ≥ 7.8 mmol/L following OGTT with 75 g 2-h, threshold: value above 92, 180 and 153 mg/dL for fasting, 1 and 2 h | O’Sullivan criteria | 1987–1988 | 605 | 5.8 | Moderate |
Lindqvist et al. 2014b | Sweden | OGTT with 75 g glucose. Threshold: value above or equal to 10 mmol/L for 2 h | European Association for the Study of Diabetes | 2011–2012 | 20,822 | 2.2 | High |
Ostlund et al. 2003a | Sweden | OGTT with 75 g 2-h, threshold: value above or equal to 6.7 and 9 mmol/L for fasting and 2 h | WHO | 1994–1996 | 4918 | 1.7 | Moderate |
O’Sullivan et al. 2011a | Ireland | 1. OGTT with 75 g 2-h, threshold: value above 5.1, 10 and 8.5 mmol/L for fasting, 1 and 2 h 2. OGTT with 75 g 2-h, threshold: value above or equal to 7 and 11 mmol/L for fasting and 2 h | 1. IADPSG 2. WHO | 2006–2009 | 1. 5500 2. 5500 | 1. 12.4 2. 9.4 | Moderate |
Bhavadharini et al. 2016b | India | 1. OGTT with 75 g 2-h, threshold: value above or equal to 5.1, 10 and 8.5 mmol/L for fasting, 1 and 2 h 2. OGTT with 75 g 2-h, threshold: value above or equal to 7.7 mmol/L for 2 h | 1. IADPSG 2. WHO | 2013–2014 | 1. 1774 2. 1774 | 1. 15.7 2. 10.5 | High |
Pu et al. 2015a | USA | OGTT with 100 g 3-h, threshold: Two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h | ICD-9 | 2007–2012 | 24,195 | 10.4 | High |
Sacks et al. 2012a | HAPO study | OGTT with 75 g 2-h, threshold: value above or equal to 5.1, 10.0 and 8.5 mmol/L for fasting, 1 and 2 h | IADPSG | 2000–2006 | 23,957 | 17.8 | High |
Schmidt et al. 2001a | Brazil | 1. OGTT with 75 g 2-h, threshold: value above or equal to 5.3, 10.0 and 8.6 mmol/L for fasting, 1 and 2 h 2. OGTT with 75 g 2-h, threshold: value above or equal to 7.0 and 7.8 mmol/L for fasting and 2 h | 1. ADA 2. WHO | 1991–1995 | 4977 | 1. 2.4 2. 7.2 | High |
Schmidt et al. 2000a | Brazil | OGTT with 75 g 2-h, threshold: value above or equal to 7.0 and 7.8 mmol/L for fasting and 2 h | WHO | 1991–1995 | 5004 | 7.6 | Moderate |
Sella et al. 2013a | Israel | GCT with 50 g 1-h, threshold: not mentioned following OGTT with 100 g 3-h, threshold: two value above 5.3, 10.0, 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h | Carpenter and Coustan criteria | 2000–2010 | 367,247 | 3.6 | High |
Seshiah et al. 2007a | India | OGTT with 75 g 2-h, threshold: value above or equal to 140 mg/dL for 2 h | WHO | 2007 | 4151 | 3.9 | Moderate |
Seshiah et al. 2008a | India | OGTT with 75 g 2-h, threshold: value above or equal to 140 mg/dL for 2 h | WHO | 2005–2007 | 12,056 | 13.9 | Moderate |
Seyoum et al. 1999a | Ethiopia | OGTT with 75 g 2-h, threshold: value above or equal to 140 mg/dL for 2 h | WHO | 1999 | 890 | 3.7 | Moderate |
Shand et al. 2008b | Australia | GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 75 g 2-h, threshold: value above 5.5 and 8.0 mmol/L for fasting and 2 h | ADIPS | 1998–2002 | 370,703 | 4.5 | High |
Sommer et al. 2014a | Norway | OGTT with 75 g 2-h, threshold: value above or equal to 5.1 and 8.5 mmol/L for fasting and 2 h | IADPSG | 2008–2010 | 728 | 31.5 | High |
Sudasingh et al. 2016b | Sri Lanka | OGTT with 75 g 2-h, threshold: value above or equal to 126 and 140 mg/dL for fasting and 2 h | WHO | 2014–2015 | 1600 | 12.1 | Moderate |
Tamayo et al. 2016b | Germany | GCT with 50 g 1-h, threshold: ≥ 135 mg/dL following OGTT with 75 g 2-h, threshold: value above 92, 180 and 153 mg/dL for fasting, 1 and 2 h | ICD-10 | 2013–2014 | 158,839 | 6.81 | Moderate |
Tan et al. 2017a | Australia | 1. OGTT with 75 g 2-h, threshold: value above or equal to 5.5 and 8.0 mmol/L for fasting and 2 h 2. OGTT with 75 g 2-h, threshold: value above or equal to 5.1, 10 and 8.5 mmol/L for fasting, 1 and 2 h | IADPSG | 2014–2015 | 2895 | 9 | High |
Trujillo et al. 2015a | Brazil | OGTT with 75 g 2-h, threshold: value above or equal to 92, 180 and 153 mg/dL for fasting, 1 and 2 h | IADPSG | 1991–1995 | 4926 | 18 | Moderate |
Wahabi et al. 20172 | Saudi Arabia | OGTT with 75 g 2-h, threshold: value above or equal to 92–125, 180 and 153–199 mg/dL for fasting, 1 and 2 h | WHO | 2013–2015 | 9723 | 24.2 | Moderate |
Wang et al. 2012b | USA | GCT with 50 g 1-h, threshold: value above or equal to 140 mg/dL following OGTT with 100 g 3-h, threshold: two value above 95, 180, 155 and 140 mg/dL for fasting, 1, 2 and 3 h | ADA | 1997–2009 | 62,685 | 4.3 | High |
Xiong et al. 2001a | Canada | GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 100 g 3-h, threshold: two value above 5.8, 10.5, 9.2 and 8 mmol/L for fasting, 1, 2 and 3 h | National criteria | 1991–1997 | 111,563 | 2.5 | Moderate |
Yang et al. 2009a | China | GCT with 50 g 1-h, threshold: value above or equal to 7.9–11.0 mmol/L following OGTT with 75 g 2-h, threshold: two value above 5.3, 10.0 and 8.6 mmol/L for fasting, 1 and 2 h | ADA | 2006 | 16,286 | 4.3 | High |
Yeung et al. 2017a | Canada | GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 75 g 2-h, threshold: two value above 5.3, 10.6 and 8.9 mmol/L for fasting, 1 and 2 h OR following OGTT with 100 g 3-h, threshold: two value above 5.3, 10.0 8.6 and 7.8 mmol/L for fasting, 1, 2 and 3 h | ICD-10 | 2004–2010 | 498,013 | 6 | High |
Zhang et al. 2011b | China | GCT with 50 g 1-h, threshold: value above or equal to 7.8 mmol/L following OGTT with 75 g 2-h, threshold: two value above 6.1-7 and 7.8 mmol/L for fasting, 1 and 2 h | WHO | 1999–2008 | 105,473 | 4.5 | High |
Zhu et al. 2017a | China | OGTT with 75 g 2-h, threshold: one value above 5.1, 10.6 and 8.5 mmol/L for fasting, 1 and 2 h | National criteria | 2013 | 15,194 | 19.7 | Moderate |
Meta-analysis and meta-regression of outcomes
Sample size of participants | I2% | P value for Begg’s test | Pooled overall prevalence (95% CI) | |
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GDM screening categorya | ||||
1 | 722,312 | 98 | 0.139 | 0.106 (0.105–0.106) |
2 | 1,662,369 | 99 | 1.000 | 0.065 (0.057–0.072) |
3 | 138,812 | 98 | 0.298 | 0.089 (0.071–0.107) |
4 | 176,966 | 0 | 0.317 | 0.022 (0.022–0.023) |
5 | 2,086,957 | 99 | 0.443 | 0.051 (0.051–0.051) |
6 | 493,168 | 98 | 0.851 | 0.029 (0.028–0.029) |
7 | 68,892 | 99 | 0.051 | 0.044 (0.013–0.074) |
Overall | 5,349,476 | 99 | 0.070 | 0.44 (0.043–0.044) |
GDM diagnostic criteria subgroups | Regression coefficient (95% CI) |
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2 vs. 1 | − 0.06 (− 0.12, − 0.00)* |
3 vs. 1 | − 0.04 (− 0.09, 0.01) |
4 vs. 1 | − 0.11 (− 0.22, − 0.00)* |
5 vs. 1 | − 0.07 (− 0.12, − 0.021)* |
6 vs. 1 | − 0.11 (− 0.18, − 0.039)* |
7 vs. 1 | − 0.09 (− 0.17, − 0.01)* |
Regions | GDM diagnostic threshold subgroup | Number of studies included | Begg’s test P-value | I2% | Pooled measure of GDM (95% CI) |
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A | 1 | 1 | – | – | 0.058 (0.039–0.076) |
2 | – | – | – | – | |
3 | 1 | – | – | 0.076 (0.072–0.080) | |
4 | – | – | – | – | |
5 | 9 | 0.602 | 99 | 0.054 (0.054–0.054) | |
6 | 6 | 0.851 | 98 | 0.029 (0.028–0.029) | |
7 | 1 | – | – | 0.017 (0.016–0.019) | |
Overall | 18 | 0.692 | 99 | 0.045 (0.044–0.045) | |
B | 1 | 6 | 0.850 | 99 | 0.152 (0.147–0.157) |
2 | – | – | – | – | |
3 | 5 | 0.625 | 99 | 0.094 (0.090–0.097) | |
4 | – | – | – | – | |
5 | – | – | – | – | |
6 | – | – | – | – | |
7 | – | – | – | – | |
Overall | 11 | 0.258 | 99 | 0.114 (0.111–0.117) | |
C | 1 | – | – | – | – |
2 | 7 | 0.625 | 99 | 0.036 (0.036–0.037) | |
3 | – | – | – | – | |
4 | – | – | – | – | |
5 | – | – | – | – | |
6 | – | – | – | – | |
7 | – | – | – | – | |
Overall | 7 | 0.625 | 99 | 0.036 (0.036–0.037) | |
D | 1 | 4 | 0.090 | 99 | 0.078 (0.076–0.081) |
2 | 1 | – | – | 0.045 (0.044–0.046) | |
3 | – | – | – | ||
4 | – | – | – | ||
5 | 2 | 0.317 | 99 | 0.053 (0.050–0.056) | |
6 | – | – | – | – | |
7 | 2 | 0.317 | 91 | 0.072 (0.070–0.075) | |
Overall | 9 | 0.051 | 99 | 0.055 (0.054–0.056) | |
E | 1 | 7 | 0.293 | 99 | 0.108 (0.107–0.108) |
2 | – | – | – | – | |
3 | 2 | 0.317 | 98 | 0.194 (0.175–0.213) | |
4 | 2 | 0.317 | 0 | 0.022 (0.022–0.023) | |
5 | – | – | – | – | |
6 | – | – | – | – | |
7 | 1 | – | – | 0.012 (0.009–0.015) | |
Overall | 12 | 0.520 | 100 | 0.060 (0.059–0.060) |