Han Shanshan, Crowther Caroline A, Middleton Philippa
ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, The University ofAdelaide, Adelaide, Australia.
Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD009037. doi: 10.1002/14651858.CD009037.pub2.
Pregnancy hyperglycaemia without meeting gestational diabetes mellitus (GDM) diagnostic criteria affects a significant proportion of pregnant women each year. It is associated with a range of adverse pregnancy outcomes. Although intensive management for women with GDM has been proven beneficial for women and their babies, there is little known about the effects of treating women with hyperglycaemia who do not meet diagnostic criteria for GDM and type 2 diabetes (T2DM).
To assess the effects of different types of management strategies for pregnant women with hyperglycaemia not meeting diagnostic criteria for GDM and T2DM (referred as borderline GDM in this review).
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011).
Randomised and cluster-randomised trials comparing alternative management strategies for women with borderline GDM.
Two review authors independently assessed study eligibility, extracted data and assessed risk of bias of included studies. Data were checked for accuracy.
We included four trials involving 543 women and their babies (but only data from 521 women and their babies is included in our analyses). Three of the four included studies had moderate to high risk of bias and one study was at low to moderate risk of bias. Babies born to women receiving management for borderline GDM (generally dietary counselling and metabolic monitoring) were less likely to be macrosomic (birthweight greater than 4000 g) (three trials, 438 infants, risk ratio (RR) 0.38, 95% confidence interval (CI) 0.19 to 0.74) or large-for-gestational (LGA) age (three trials, 438 infants, RR 0.37, 95% CI 0.20 to 0.66) when compared with those born to women in the routine care group. There were no significant differences in rates of caesarean section (three trials, 509 women, RR 0.93, 95% CI 0.68 to 1.27) and operative vaginal birth (one trial, 83 women, RR 1.37, 95% CI 0.20 to 9.27) between the two groups.
AUTHORS' CONCLUSIONS: This review found interventions including providing dietary advice and blood glucose level monitoring for women with pregnancy hyperglycaemia not meeting GDM and T2DM diagnostic criteria helped reduce the number of macrosomic and LGA babies without increasing caesarean section and operative vaginal birth rates. It is important to notice that the results of this review were based on four small randomised trials with moderate to high risk of bias without follow-up outcomes for both women and their babies.
每年有相当比例的孕妇出现未达到妊娠期糖尿病（GDM）诊断标准的妊娠高血糖情况。它与一系列不良妊娠结局相关。尽管已证实对GDM女性进行强化管理对母婴有益，但对于治疗未达到GDM和2型糖尿病（T2DM）诊断标准的高血糖女性的效果却知之甚少。
评估针对未达到GDM和T2DM诊断标准的妊娠高血糖孕妇（本综述中称为临界GDM）的不同管理策略的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2011年9月30日）。
比较临界GDM女性替代管理策略的随机和整群随机试验。
两位综述作者独立评估研究的合格性，提取数据并评估纳入研究的偏倚风险。检查数据的准确性。
我们纳入了四项试验，涉及543名妇女及其婴儿（但我们的分析仅包括521名妇女及其婴儿的数据）。纳入的四项研究中有三项存在中度至高偏倚风险，一项研究存在低至中度偏倚风险。与常规护理组的妇女所生婴儿相比，接受临界GDM管理（通常为饮食咨询和代谢监测）的妇女所生婴儿出现巨大儿（出生体重超过4000g）的可能性较小（三项试验，438名婴儿，风险比（RR）0.38，95%置信区间（CI）0.19至0.74）或大于胎龄（LGA）儿的可能性较小（三项试验，438名婴儿，RR 0.37，95%CI 0.20至0.66）。两组之间剖宫产率（三项试验，509名妇女，RR 0.93，95%CI 0.68至1.27）和阴道助产率（一项试验，83名妇女，RR 1.37，95%CI 0.20至9.27）无显著差异。
本综述发现，对未达到GDM和T2DM诊断标准的妊娠高血糖女性进行包括提供饮食建议和血糖水平监测在内的干预措施，有助于减少巨大儿和LGA儿的数量，且不增加剖宫产率和阴道助产率。需要注意的是，本综述的结果基于四项小型随机试验，存在中度至高偏倚风险，且未对妇女及其婴儿进行随访结局评估。
