Department of General Practice, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia.
BMC Womens Health. 2010 Jan 31;10:5. doi: 10.1186/1472-6874-10-5.
The prevalence of type 2 diabetes mellitus (T2DM) continues to rise worldwide. More women from developing countries who are in the reproductive age group have diabetes resulting in more pregnancies complicated by T2DM, and placing both mother and foetus at higher risk. Management of these risks is best achieved through comprehensive preconception care and glycaemic control, both prior to, and during pregnancy. The aim of this review was to compare the quality and content of current guidelines concerned with the preconception care of women with diabetes and to develop a summary of recommendations to assist in the management of diabetic women contemplating pregnancy.
Relevant clinical guidelines were identified through a search of several databases (MEDLINE, SCOPUS and The Cochrane Library) and relevant websites. Five guidelines were identified. Each guideline was assessed for quality using the AGREE instrument. Guideline recommendations were extracted, compared and contrasted.
All guidelines were assessed as being of high quality and strongly recommended for use in practice. All were consistent in counselling about the risk of congenital malformation related to uncontrolled blood sugar preconceptionally, ensuring adequate contraception until glycaemic control is achieved, use of HBA1C to monitor metabolic control, when to commence insulin and switching from ACE inhibitors to other antihypertensives. Major differences were in the targets recommended for optimal metabolic control and opinion regarding the usage of metformin as an adjunct or alternative treatment before or during pregnancy.
International guidelines for the care of women with diabetes who are contemplating pregnancy are consistent in their recommendations; however some are more comprehensive than others. Having established current standards for the preconception care of diabetic women, there is now a need to focus on guideline implementation through an examination of the barriers and enablers to successful implementation, and the applicability of the recommendations in the local setting.
全球范围内 2 型糖尿病（T2DM）的患病率持续上升。越来越多来自发展中国家、处于生育年龄阶段的女性患有糖尿病，导致更多妊娠合并 T2DM，使母亲和胎儿面临更高的风险。通过全面的孕前保健和血糖控制，可以最好地管理这些风险，这在怀孕前和怀孕期间都很重要。本综述旨在比较当前有关糖尿病女性孕前保健的指南的质量和内容，并总结建议，以协助管理有妊娠计划的糖尿病女性。
通过搜索多个数据库（MEDLINE、SCOPUS 和 The Cochrane Library）和相关网站，确定了相关的临床指南。确定了 5 条指南。使用 AGREE 工具评估每条指南的质量。提取、比较和对比指南建议。
所有指南均被评估为高质量，并强烈建议在实践中使用。所有指南都一致建议在孕前咨询未控制的血糖相关先天性畸形风险，确保在血糖控制达到目标前使用足够的避孕措施，使用 HBA1C 监测代谢控制，何时开始使用胰岛素以及将 ACE 抑制剂转换为其他降压药。主要差异在于建议的最佳代谢控制目标以及关于在孕前或怀孕期间使用二甲双胍作为辅助或替代治疗的意见。
有妊娠计划的糖尿病女性的国际护理指南在其建议方面是一致的；然而，有些指南比其他指南更全面。已经为糖尿病女性的孕前保健确立了当前标准，现在需要通过检查成功实施的障碍和促进因素，以及建议在当地环境中的适用性，来关注指南的实施。
