Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
Am J Obstet Gynecol. 2011 Sep;205(3):253.e1-7. doi: 10.1016/j.ajog.2011.06.026. Epub 2011 Jun 15.
The objective of the study was to compare perinatal outcomes among women diagnosed with gestational diabetes by the National Diabetes Data Group (NDDG) criteria with women meeting only Carpenter-Coustan criteria.
This was a 14 year retrospective cohort. Women who screened positive with 1 hour glucose load 140 mg/dL or greater underwent a diagnostic 3 hour oral glucose tolerance test. We report adjusted prevalence ratios (aPRs) of perinatal outcome risk.
Of the 4659 screen-positive women with diagnostic testing, 1082 (3.3%, of 33,179) met NDDG criteria; 1542 (4.6%, of 33,179), or 460 more, met Carpenter-Coustan criteria. These 460 untreated women had greater risk of preeclampsia than women diagnosed by NDDG criteria (aPR, 1.70; 95% confidence interval [CI], 1.23-2.35). They had a greater risk of cesarean delivery (aPR, 1.16; 95% CI, 1.04-1.30) and infants greater than 4000 g (aPR, 1.25; 95% CI, 1.01-1.56) than women not meeting either diagnostic criteria.
The 42.5% additional women diagnosed only by Carpenter-Coustan criteria are at greater risk for some adverse outcomes. Cost-effectiveness of a change remains to be determined.
本研究旨在比较符合全国糖尿病数据组（NDDG）标准的妊娠期糖尿病患者与仅符合 Carpenter-Coustan 标准的患者的围产期结局。
这是一项为期 14 年的回顾性队列研究。在 1 小时葡萄糖负荷 140mg/dL 或更高时筛查阳性的女性接受诊断性 3 小时口服葡萄糖耐量试验。我们报告围产期结局风险的调整患病率比（aPR）。
在接受诊断性检测的 4659 名筛查阳性女性中，1082 名（3.3%，33179 名中的 1082 名）符合 NDDG 标准；1542 名（4.6%，33179 名中的 1542 名），或 460 名更多，符合 Carpenter-Coustan 标准。这些未经治疗的 460 名女性发生子痫前期的风险高于符合 NDDG 标准的女性（aPR，1.70；95%置信区间 [CI]，1.23-2.35）。她们剖宫产的风险更高（aPR，1.16；95%CI，1.04-1.30），婴儿体重超过 4000g 的风险也更高（aPR，1.25；95%CI，1.01-1.56）。
仅符合 Carpenter-Coustan 标准的女性中，42.5%的女性存在某些不良结局的风险增加。改变的成本效益仍有待确定。
