Griffin M E, Coffey M, Johnson H, Scanlon P, Foley M, Stronge J, O'Meara N M, Firth R G
Department of Diabetes and Endocrinology, Mater Misericordiae Hospital, Dublin, Ireland.
Diabet Med. 2000 Jan;17(1):26-32. doi: 10.1046/j.1464-5491.2000.00214.x.
Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcome. Screening for GDM is therefore recommended but the best screening method remains controversial. This prospective, randomized study compared a risk factor-based screening programme with a universally based one.
Subjects were randomized at booking to one of two groups: the risk factor group had a 3-h 100-g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50-g glucose challenge test performed and if their plasma glucose at 1 h was > or = 7.8 mmol/l, a formal 3-h 100-g OGTT was then performed.
Universal screening detected a prevalence of GDM of 2.7%, significantly more than the 1.45% detected in the risk factor screened group (P<0.03). Universal screening facilitated earlier diagnosis than risk factor screening - mean gestation 30 +/- 2.6 weeks vs. 33 +/- 3.7 weeks (P<0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of macrosomia, Caesarean section, prematurity, pre-eclampsia and admission to neonatal intensive care unit were observed in the universally screened, early diagnosis group.
Universal screening for GDM is superior to risk factor based screening-detecting more cases, facilitating early diagnosis and is associated with improved pregnancy outcome.
妊娠期糖尿病（GDM）与不良母婴结局相关。因此推荐进行GDM筛查，但最佳筛查方法仍存在争议。本前瞻性随机研究比较了基于风险因素的筛查方案与普遍筛查方案。
受试者在首次产前检查时随机分为两组：风险因素组如果存在任何GDM风险因素，则在孕32周时进行3小时100克口服葡萄糖耐量试验（OGTT）；普遍筛查组进行50克葡萄糖耐量试验，如果其1小时血浆葡萄糖≥7.8毫摩尔/升，则进行正式的3小时100克OGTT。
普遍筛查检测出GDM患病率为2.7%，显著高于风险因素筛查组的1.45%（P<0.03）。普遍筛查比风险因素筛查能更早诊断——平均孕周分别为30±2.6周和33±3.7周（P<0.05）。在普遍筛查的早期诊断组中，足月自然阴道分娩率较高，巨大儿、剖宫产、早产、子痫前期和新生儿重症监护病房收治率较低。
GDM普遍筛查优于基于风险因素的筛查——能检测出更多病例，便于早期诊断，并与改善妊娠结局相关。
