Tieu Joanna, McPhee Andrew J, Crowther Caroline A, Middleton Philippa
ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 1st floor, Queen Victoria Building, 72 King William Road, Adelaide, South Australia, Australia, 5006.
Cochrane Database Syst Rev. 2014 Feb 11(2):CD007222. doi: 10.1002/14651858.CD007222.pub3.
Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. There is strong evidence to support treatment for GDM. However, there is little consensus on whether or not screening for GDM will improve maternal and infant health and if so, the most appropriate protocol to follow.
To assess the effects of different methods of screening for GDM and maternal and infant outcomes.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013).
Randomised and quasi-randomised trials evaluating the effects of different methods of screening for GDM.
Two review authors independently conducted data extraction and quality assessment. We resolved disagreements through discussion or through a third author.
We included four trials involving 3972 women in the review. One quasi-randomised trial compared risk factor screening with universal or routine screening by 50 g oral glucose challenge testing. Women in the universal screening group were more likely to be diagnosed with GDM (one trial, 3152 women, risk ratio (RR) 0.44, 95% confidence interval (CI) 0.26 to 0.75). This trial did not report on the other primary outcomes of the review (positive screen for GDM, mode of birth, large-for-gestational age, or macrosomia). Considering secondary outcomes, infants of mothers in the risk factor screening group were born marginally earlier than infants of mothers in the routine screening group (one trial, 3152 women, mean difference (MD) -0.15 weeks, 95% CI -0.27 to -0.03).The remaining three trials evaluated different methods of administering a 50 g glucose load. Two small trials compared glucose monomer with glucose polymer testing, with one of these trials including a candy bar group. One trial compared a glucose solution with food. No differences in diagnosis of GDM were found between each comparison. However, in one trial significantly more women in the glucose monomer group screened positive for GDM than women in the candy bar group (80 women, RR 3.49, 95% CI 1.05 to 11.57). The three trials did not report on the primary review outcomes of mode of birth, large-for-gestational age or macrosomia. Overall, women drinking the glucose monomer experienced fewer side effects from testing than women drinking the glucose polymer (two trials, 151 women, RR 2.80, 95% CI 1.10 to 7.13). However, we observed substantial heterogeneity between the trials for this result (I² = 61%).
AUTHORS' CONCLUSIONS: There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes.
妊娠期糖尿病（GDM）是一种在孕期发生的糖尿病形式。尽管GDM通常在产后缓解，但它在围产期和长期内都与母婴的重大发病风险相关。有强有力的证据支持对GDM进行治疗。然而，对于GDM筛查是否会改善母婴健康以及如果会改善，应遵循何种最合适的方案，几乎没有共识。
评估不同GDM筛查方法及母婴结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2013年12月1日）。
评估不同GDM筛查方法效果的随机和半随机试验。
两位综述作者独立进行数据提取和质量评估。我们通过讨论或第三位作者解决分歧。
我们纳入了四项试验，涉及3972名女性。一项半随机试验比较了风险因素筛查与通过50克口服葡萄糖耐量试验进行的普遍或常规筛查。普遍筛查组的女性更有可能被诊断为GDM（一项试验，3152名女性，风险比（RR）0.44，95%置信区间（CI）0.26至0.75）。该试验未报告综述的其他主要结局（GDM筛查阳性、分娩方式、大于胎龄儿或巨大儿）。考虑次要结局，风险因素筛查组母亲的婴儿出生时间比常规筛查组母亲的婴儿略早（一项试验，3152名女性，平均差（MD）-0.15周，95%CI -0.27至-0.03）。其余三项试验评估了给予50克葡萄糖负荷的不同方法。两项小型试验比较了葡萄糖单体与葡萄糖聚合物检测，其中一项试验包括了糖果棒组。一项试验比较了葡萄糖溶液与食物。各比较组之间在GDM诊断方面未发现差异。然而，在一项试验中，葡萄糖单体组筛查GDM阳性的女性显著多于糖果棒组（80名女性，RR 3.49，95%CI 1.05至11.57）。这三项试验未报告分娩方式、大于胎龄儿或巨大儿等主要综述结局。总体而言，饮用葡萄糖单体的女性在检测中出现的副作用少于饮用葡萄糖聚合物的女性（两项试验，151名女性，RR 2.80，95%CI 1.10至7.13）。然而，我们观察到该结果在试验之间存在实质性异质性（I² = 61%）。
没有足够的证据来确定妊娠期糖尿病筛查或何种类型的筛查是否能改善母婴健康结局。
