Ben-Haroush A, Yogev Y, Hod M
Perinatal Division and WHO Collaborating Centre for Perinatal Care, Department of Obstetrics and Gynaecology, Rabin Medical Centre, Beilinson Campus, Petah Tiqva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Diabet Med. 2004 Feb;21(2):103-13. doi: 10.1046/j.1464-5491.2003.00985.x.
Gestational diabetes (GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. Although it is a well-known cause of pregnancy complications, its epidemiology has not been studied systematically. Our aim was to review the recent data on the epidemiology of GDM, and to describe the close relationship of GDM to prediabetic states, in addition to the risk of future deterioration in insulin resistance and development of overt Type 2 diabetes. We found that differences in screening programmes and diagnostic criteria make it difficult to compare frequencies of GDM among various populations. Nevertheless, ethnicity has been proven to be an independent risk factor for GDM, which varies in prevalence in direct proportion to the prevalence of Type 2 diabetes in a given population or ethnic group. There are several identifiable predisposing factors for GDM, and in the absence of risk factors, the incidence of GDM is low. Therefore, some authors suggest that selective screening may be cost-effective. Importantly, women with an early diagnosis of GDM, in the first half of pregnancy, represent a high-risk subgroup, with an increased incidence of obstetric complications, recurrent GDM in subsequent pregnancies, and future development of Type 2 diabetes. Other factors that place women with GDM at increased risk of Type 2 diabetes are obesity and need for insulin for glycaemic control. Furthermore, hypertensive disorders in pregnancy and afterwards may be more prevalent in women with GDM. We conclude that the epidemiological data suggest an association between several high-risk prediabetic states, GDM, and Type 2 diabetes. Insulin resistance is suggested as a pathogenic linkage. It is possible that improving insulin sensitivity with diet, exercise and drugs such as metformin may reduce the risk of diabetes in individuals at high risk, such as women with polycystic ovary syndrome, impaired glucose tolerance, and a history of GDM. Large controlled studies are needed to clarify this issue and to develop appropriate diabetic prevention strategies that address the potentially modifiable risk factors.
妊娠期糖尿病（GDM）被定义为在妊娠期开始或首次被识别的碳水化合物不耐受。尽管它是妊娠并发症的一个众所周知的原因，但其流行病学尚未得到系统研究。我们的目的是回顾妊娠期糖尿病流行病学的最新数据，并描述妊娠期糖尿病与糖尿病前期状态的密切关系，以及未来胰岛素抵抗恶化和显性2型糖尿病发生的风险。我们发现，筛查方案和诊断标准的差异使得不同人群中妊娠期糖尿病的发病率难以比较。然而，种族已被证明是妊娠期糖尿病的一个独立危险因素，其患病率与特定人群或种族中2型糖尿病的患病率成正比。妊娠期糖尿病有几个可识别的易感因素，在没有危险因素的情况下，妊娠期糖尿病的发病率较低。因此，一些作者建议选择性筛查可能具有成本效益。重要的是，在妊娠前半期早期诊断为妊娠期糖尿病的女性代表一个高危亚组，产科并发症、后续妊娠中复发性妊娠期糖尿病以及未来2型糖尿病发生的发生率增加。使妊娠期糖尿病女性患2型糖尿病风险增加的其他因素包括肥胖和血糖控制需要胰岛素。此外，妊娠期及之后的高血压疾病在妊娠期糖尿病女性中可能更普遍。我们得出结论，流行病学数据表明几种高危糖尿病前期状态、妊娠期糖尿病和2型糖尿病之间存在关联。胰岛素抵抗被认为是一种致病联系。通过饮食、运动和二甲双胍等药物改善胰岛素敏感性可能会降低高危个体如多囊卵巢综合征、糖耐量受损和有妊娠期糖尿病病史的女性患糖尿病的风险。需要大型对照研究来阐明这个问题，并制定适当的糖尿病预防策略，以解决潜在的可改变的危险因素。
