Conway Deborah L
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health Science Center-San Antonio, 7703 Floyd Curl Dr., San Antonio, TX 78229, USA.
Diabetes Care. 2007 Jul;30 Suppl 2:S175-9. doi: 10.2337/dc07-s212.
Reviewing the areas of controversy related to the obstetric management of women with GDM, we are unfortunately unable to provide significant refinement of the recommendations agreed upon after the Fourth International Workshop-Conference due to the lack of properly controlled and powered clinical studies in this area since 1997. In the area of the need for antenatal fetal surveillance in women with milder degrees of GDM, we may be able to draw indirect conclusions from ongoing cohort studies that will include large numbers of women. In the area of optimal timing and mode of delivery to avoid fetal injury, large well-controlled prospective studies do not currently exist and are urgently needed. In addition, refinement of fetal and pelvic imaging techniques to more accurately identify the maternal-fetal pairs most likely to benefit from avoiding vaginal delivery, and the more widespread availability of these technologies, may also prove to be of benefit in the obstetric management of women with GDM.
回顾与妊娠期糖尿病（GDM）女性产科管理相关的争议领域，遗憾的是，由于自1997年以来该领域缺乏适当对照且样本量充足的临床研究，我们无法对第四次国际研讨会后达成的建议进行重大完善。在轻度GDM女性是否需要产前胎儿监测这一领域，我们或许能够从正在进行的队列研究中得出间接结论，这些研究将纳入大量女性。在为避免胎儿损伤而确定最佳分娩时机和方式的领域，目前尚无大规模、对照良好的前瞻性研究，而这一需求十分迫切。此外，改进胎儿和盆腔成像技术以更准确地识别最有可能从避免阴道分娩中获益的母婴对，以及这些技术更广泛的可及性，在GDM女性的产科管理中可能也会有所助益。
