Kelly Len, Evans Laura, Messenger David
McMaster University's Family Medicine North, Sioux Lookout, Ont.
Can Fam Physician. 2005 May;51(5):688-95.
To summarize some of the issues facing primary care physicians who are seeing increasing numbers of patients with gestational diabetes mellitus (GDM) and to explore new developments in use of oral hypoglycemics during pregnancy.
All the literature on screening for GDM offers level III evidence. Much of the literature on treatment is also level III, but newer studies offer level I evidence and are more useful for daily practice. Existing research leaves many important questions unanswered; research findings are inconsistent among studies, and treatment strategies are challenging to implement.
Recent studies have clarified that rates of neonatal mortality and congenital malformations are not higher among the offspring of mothers with GDM. Treatment might affect birth weight, but whether treatment is associated with reductions in rates of shoulder dystocia and cesarean section is unclear. Several level I studies conclude that the oral hypoglycemic glyburide can be used safely and effectively during the second and third trimesters of pregnancy.
Management of GDM remains a controversial area in obstetric care. It is a growing area of research, and new developments that might clarify risk and simplify treatment are expected in the coming years.
总结基层医疗医生在诊治越来越多的妊娠期糖尿病（GDM）患者时面临的一些问题，并探讨孕期口服降糖药使用方面的新进展。
所有关于GDM筛查的文献提供的是Ⅲ级证据。许多关于治疗的文献也是Ⅲ级，但较新的研究提供了Ⅰ级证据，对日常实践更有用。现有研究留下了许多重要问题未得到解答；研究结果在各研究之间不一致，治疗策略实施起来具有挑战性。
近期研究已明确，GDM母亲的后代中新生儿死亡率和先天性畸形率并不更高。治疗可能会影响出生体重，但治疗是否与肩难产和剖宫产率降低相关尚不清楚。几项Ⅰ级研究得出结论，口服降糖药格列本脲在妊娠第二和第三孕期可安全有效地使用。
GDM的管理在产科护理中仍是一个有争议的领域。这是一个不断发展的研究领域，预计未来几年可能会有新进展，从而阐明风险并简化治疗。
