Virally M, Laloi-Michelin M, Meas T, Ciraru N, Ouled N, Médeau V, Kevorkian J P, Truc J B, Guillausseau P J
Department of Medicine B, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (APHP), University Paris-VII, 2 rue Ambroise-Paré, 75010 Paris, France.
Diabetes Metab. 2007 Sep;33(4):290-5. doi: 10.1016/j.diabet.2007.03.003. Epub 2007 Jul 24.
Among the numerous guidelines defining the diagnostic strategy of gestational diabetes mellitus (GDM), none of them suggest a follow-up in women with risk factors beyond the 28th week of gestation (WG). The primary objective of this study was to assess the incidence of GDM beyond 28 WG in a group of women at high risk. The secondary objectives were to evaluate maternal and fetal outcomes in early and late GDM (between 24-28 WG, and beyond 28 WG), as well as to compare them to a normal glucose tolerance (NGT) group.
A prospective study conducted in 191 consecutive women. Between 24-28 WG, the diagnosis of GDM was performed in a two-step approach (50 then 75 g). Beyond the 28 WG, the diagnosis of GDM was based on self-monitoring blood glucose (SMBG). All women were educated about an individualized diabetic diet and to perform SMBG daily glucose profiles.
Seventy-two percent of the women at risk had developed GDM. Among these, 54% had developed early GDM, between 24-28 WG, and 18% had developed late GDM, beyond the 28th WG. Gestational age of late GDM was estimated 30 WG. In late GDM, onset of diabetes seems to be predicted by an increase in capillary glucose value determined at 22:00 hours, but this needs to be confirmed. Women who develop GDM2 have a significantly higher rate of macrosomia and more important pre-pregnancy overweight, underlining this impact in the occurrence of macrosomia. Finally maternal outcomes were not different in the 3 groups with intensive intervention.
在众多定义妊娠期糖尿病（GDM）诊断策略的指南中，没有一个建议对妊娠28周（WG）后有风险因素的女性进行随访。本研究的主要目的是评估一组高危女性中妊娠28周后GDM的发生率。次要目的是评估早期和晚期GDM（妊娠24 - 28周之间以及28周后）的母婴结局，并将其与正常糖耐量（NGT）组进行比较。
对191名连续的女性进行前瞻性研究。在妊娠24 - 28周期间，采用两步法（50克然后75克）进行GDM诊断。在妊娠28周后，GDM的诊断基于自我血糖监测（SMBG）。所有女性都接受了个体化糖尿病饮食教育，并要求每天进行SMBG血糖谱监测。
72%的高危女性发生了GDM。其中，54%发生了早期GDM（妊娠24 - 28周之间），18%发生了晚期GDM（妊娠28周后）。晚期GDM的孕周估计为30周。在晚期GDM中，糖尿病的发作似乎可以通过22:00时测定的毛细血管血糖值升高来预测，但这需要进一步证实。发生GDM2的女性巨大儿发生率显著更高，且孕前超重情况更严重，这突出了其在巨大儿发生中的影响。最后，三组经过强化干预后的母亲结局并无差异。
