Oriot P, Selvais P, Radikov J, Jacobs J L, Gilleman U, Loumaye R, Fernandez C
Acta Clin Belg. 2014 Jan-Feb;69(1):8-11. doi: 10.1179/0001551213Z.0000000004.
We have conducted a systematic universal screening for gestational diabetes mellitus (GDM) since 2008, following the criteria outlined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) since 2011. However, we recently replaced the IADPSG standards with those established by the Belgian French Language Gynecologists and Obstetricians Group (GGOLFB). These new criteria indicate GDM when fasting plasma glucose (FPG) is ≥0·92 g/l at the beginning of pregnancy or when an orally provoked hyperglycaemia test (75 g of glucose) between the twenty-fourth and twenty-eighth week results in an FPG of ≥0·92 g/l and/or ≥1·80 g/l after 1 hour and/or ≥1·53 g/l after 2 hours. The goal of this retrospective study was to evaluate the incidence of GDM, neonatal outcomes, and the use of insulin therapy 21 months post-implementation of the IADPSG criteria within our centre. A total of 393 patients were diagnosed with GDM from January 2009 to December 2012. After applying the new criteria, the incidence of GDM rose significantly from 8 to 23% (P<0·0001). However, there were no significant changes in the proportion of GDM patients requiring insulin therapy (34·2% versus 34·7%) or the rate of foetal large for gestational age (11·2% versus 8·8%). In addition, the ≥90% percentile decreased non-significantly from 96·3±0·6% to 94·3±0·70% (P = 0·057), whereas the lower quartiles and the proportion of cesarean deliveries (27·0% versus 25·6%) did not change significantly. Therefore, non-targeted screening significantly increased the incidence of GDM in our centre without significantly decreasing large for gestational age or the number of cesarean deliveries.
自2008年起,我们一直按照国际糖尿病与妊娠研究组(IADPSG)自2011年起制定的标准,对妊娠期糖尿病(GDM)进行系统的普遍筛查。然而,我们最近将IADPSG标准替换为比利时法语区妇产科医生小组(GGOLFB)制定的标准。这些新标准规定,妊娠初期空腹血糖(FPG)≥0·92 g/l,或在孕24至28周进行口服葡萄糖耐量试验(75 g葡萄糖)时,FPG≥0·92 g/l,和/或1小时后≥1·80 g/l,和/或2小时后≥1·53 g/l,即诊断为GDM。这项回顾性研究的目的是评估在我们中心实施IADPSG标准21个月后GDM的发病率、新生儿结局以及胰岛素治疗的使用情况。2009年1月至2012年12月期间,共有393例患者被诊断为GDM。应用新标准后,GDM的发病率从8%显著上升至23%(P<0·0001)。然而,需要胰岛素治疗的GDM患者比例(34·2%对34·7%)或大于胎龄儿的发生率(11·2%对8·8%)没有显著变化。此外,第90百分位数从96·3±0·6%降至94·3±0·70%,差异无统计学意义(P = 0·057),而较低四分位数和剖宫产比例(27·0%对25·6%)没有显著变化。因此,非针对性筛查显著增加了我们中心GDM的发病率,而没有显著降低大于胎龄儿的发生率或剖宫产数量。