Simmons David, Rowan Janet, Reid Rosemary, Campbell Norma
Institute of Metabolic Science, PO Box 281, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, England.
N Z Med J. 2008 Mar 14;121(1270):74-86.
Rates of gestational diabetes mellitus (GDM) and Type 2 diabetes in pregnancy are increasing with the epidemic of obesity. GDM is associated with significant perinatal morbidity and future risk of permanent diabetes in the mother and obesity and diabetes in the offspring. The recent Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) has shown maternal and perinatal benefits of managing GDM once diagnosed. The criteria for GDM are under review following the recent completion of the Hyperglycaemia and Adverse Perinatal Outcomes study (HAPO). In New Zealand, the approach to identifying women with GDM or undiagnosed Type 2 diabetes has varied. The National GDM Technical Working Party reviewed the available data in the New Zealand context and recommend that (1) All pregnant women are offered screening for GDM backed up with relevant educational, systems and materials for health professionals and the women; (2) Criteria for GDM should remain unchanged pending further information (which should be actively sought); (3) Women at high risk of undiagnosed Type 2 diabetes in pregnancy should be screened at booking: the HbA1c was recommended as a practical initial screening test, but further research is needed; and (4) A structured, audited, population-based approach to managing women with GDM should be introduced in each district.
随着肥胖症的流行，妊娠期糖尿病（GDM）和妊娠合并2型糖尿病的发病率正在上升。GDM与显著的围产期发病率以及母亲患永久性糖尿病的未来风险、后代肥胖和糖尿病相关。最近的澳大利亚孕妇碳水化合物不耐受研究（ACHOIS）表明，一旦确诊，管理GDM对母亲和围产期有益。在高血糖与不良围产期结局研究（HAPO）近期完成后，GDM的诊断标准正在接受审查。在新西兰，识别患有GDM或未确诊2型糖尿病的女性的方法各不相同。国家GDM技术工作小组审查了新西兰背景下的现有数据，并建议：（1）为所有孕妇提供GDM筛查，并为卫生专业人员和孕妇提供相关教育、系统和资料；（2）在获得更多信息之前（应积极寻求），GDM的诊断标准应保持不变；（3）妊娠期间未确诊2型糖尿病高危女性应在首次产前检查时进行筛查：推荐糖化血红蛋白（HbA1c）作为实用的初始筛查试验，但仍需进一步研究；（4）每个地区应采用结构化、经过审核、基于人群的方法来管理患有GDM的女性。
