Hammoud Nurah M, de Valk Harold W, Biesma Douwe H, Visser Gerard H A
University Medical Center Utrecht, Division Woman & Baby, Utrecht, The Netherlands.
J Matern Fetal Neonatal Med. 2013 Jan;26(1):103-5. doi: 10.3109/14767058.2012.722718. Epub 2012 Sep 25.
To investigate whether outcome differs between pregnancies complicated by gestational diabetes mellitus (GDM), which was either detected by risk-factor based screening when no clinical signs are apparent (screening-group) or due to clinical signs of hyperglycemia (e.g. accelerated fetal growth or hydramnios) (diagnosis-group).
A retrospective cohort of 249 patients with GDM treated between 2006 and 2009 were identified: 74 in the diagnosis-group and 175 in the screening-group. Fetal macrosomia was defined as an abdominal circumference (FAC) >90th percentile at the time of diagnosis of GDM. Large for gestational age (LGA) was defined as a birthweight >90th percentile, corrected for gestational age, parity and sex.
GDM was diagnosed 4 weeks later in the diagnosis-group. At diagnosis of GDM, more infants in the diagnosis-group had a FAC >p90 and at birth more infants in this group were LGA.
GDM diagnosed by screening is associated with a lower incidence of fetal and neonatal macrosomia than GDM diagnosed by clinical symptoms. A later diagnosis of GDM is more prevalent in presumed low-risk pregnancies. These results favour a policy of routine screening.
探讨在无明显临床症状时通过基于风险因素的筛查诊断的妊娠期糖尿病（GDM）孕妇与因高血糖临床症状（如胎儿生长加速或羊水过多）诊断的GDM孕妇的妊娠结局是否存在差异。
确定了2006年至2009年间接受治疗的249例GDM患者的回顾性队列：诊断组74例，筛查组175例。巨大儿定义为GDM诊断时腹围（FAC）>第90百分位数。大于胎龄儿（LGA）定义为出生体重>第90百分位数，并根据胎龄、产次和性别进行校正。
诊断组GDM诊断时间晚4周。在GDM诊断时，诊断组更多婴儿的FAC>第90百分位数，且该组出生时更多婴儿为LGA。
与通过临床症状诊断的GDM相比，通过筛查诊断的GDM胎儿和新生儿巨大儿的发生率较低。在假定的低风险妊娠中，GDM诊断较晚更为普遍。这些结果支持常规筛查策略。
