Cheng Yvonne W, Block-Kurbisch Ingrid, Caughey Aaron B
From the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):326-332. doi: 10.1097/AOG.0b013e3181ae8d85.
To examine perinatal outcomes in women who would meet the diagnostic criteria for gestational diabetes mellitus (GDM) according to the Carpenter and Coustan but not by the National Diabetes Data Group (NDDG) thresholds.
This is a retrospective cohort study of women screened for GDM between January 1988 and December 2001. During the study period, only women who were diagnosed with GDM by the NDDG criteria received counseling and treatment. Women diagnosed with GDM according to the Carpenter and Coustan thresholds but not by the NDDG criteria were compared with women without GDM by either criteria. Perinatal outcomes were examined using chi test and multivariable logistic regression analyses.
Among the 14,693 women screened for GDM, 753 (5.1%) would have GDM diagnosed by the Carpenter and Coustan criteria and 480 (3.3%) by the NDDG criteria only, giving 273 (1.9%) women as the study group. Compared with women without GDM, women with GDM by the Carpenter and Coustan but not by the NDDG criteria had higher odds of cesarean delivery (OR 1.44, 95% confidence interval [CI] 1.01-2.07), operative vaginal delivery (OR 1.72, 95% CI 1.20-2.46), birth weight greater than 4,500 g (OR 4.47, 95% CI 2.26-8.86), and shoulder dystocia (OR 2.24, 95% CI 1.03-4.88).
Women diagnosed with GDM by the Carpenter and Coustan criteria but not by the NDDG criteria had higher risk of operative deliveries, macrosomia, and shoulder dystocia. We recommend using the Carpenter and Coustan diagnostic thresholds for GDM, because these diagnostic criteria are more sensitive than the NDDG criteria.
II.
研究依据卡彭特（Carpenter）和库斯坦（Coustan）标准符合妊娠期糖尿病（GDM）诊断标准，但不符合美国国家糖尿病数据组（NDDG）阈值的女性的围产期结局。
这是一项对1988年1月至2001年12月期间接受GDM筛查的女性进行的回顾性队列研究。在研究期间，只有依据NDDG标准被诊断为GDM的女性接受咨询和治疗。将依据卡彭特和库斯坦阈值但未依据NDDG标准诊断为GDM的女性与两种标准下均未患GDM的女性进行比较。使用卡方检验和多变量逻辑回归分析来研究围产期结局。
在14693名接受GDM筛查的女性中，753名（5.1%）依据卡彭特和库斯坦标准会被诊断为GDM，仅480名（3.3%）依据NDDG标准被诊断为GDM，从而确定273名（1.9%）女性为研究组。与未患GDM的女性相比，依据卡彭特和库斯坦标准但未依据NDDG标准患GDM的女性剖宫产（比值比[OR]1.44，95%置信区间[CI]1.01 - 2.07）、阴道助产（OR 1.72，95% CI 1.20 - 2.46）、出生体重超过4500g（OR 4.47，95% CI 2.26 - 8.86）及肩难产（OR 2.24，95% CI 1.03 - 4.88）的几率更高。
依据卡彭特和库斯坦标准但未依据NDDG标准诊断为GDM的女性手术分娩、巨大儿和肩难产风险更高。我们建议使用卡彭特和库斯坦GDM诊断阈值，因为这些诊断标准比NDDG标准更敏感。
II级。
