Hung Tai-Ho, Hsieh T'sang-T'ang
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan; Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan.
PLoS One. 2015 Mar 10;10(3):e0122261. doi: 10.1371/journal.pone.0122261. eCollection 2015.
In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommended a new strategy for the screening and diagnosis of gestational diabetes mellitus (GDM). However, no study has indicated that adopting the IADPSG recommendations improves perinatal outcomes. The objective of this study was to evaluate the effects of implementing the IADPSG criteria for diagnosing GDM on maternal and neonatal outcomes.
METHODOLOGY/PRINCIPAL FINDINGS: Previously, we used a two-step approach (a 1-h, 50-g glucose challenge test followed by a 3-h, 100-g glucose tolerance test when indicated) to screen for and diagnose GDM. In July 2011, we adopted the IADPSG recommendations in our routine obstetric care. In this study, we retrospectively compared the rates of various maternal and neonatal outcomes in all women who delivered after 24 weeks of gestation during the periods before (P1, between January 1, 2009 and December 31, 2010) and after (P2, between January 1, 2012 and December 31, 2013) the IADPSG criteria were implemented. Pregnancies complicated by multiple gestations, fetal chromosomal or structural anomalies, and pre-pregnancy diabetes mellitus were excluded. Our results showed that the incidence of GDM increased from 4.6% using the two-step method to 12.4% using the IADPSG criteria. Compared to the women in P1, the women in P2 experienced less weight gain during pregnancy, lower birth weights, shorter labor courses, and lower rates of macrosomia (<4000 g) and large-for-gestational age (LGA) infants. P2 was a significant independent factor against macrosomia (adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.90) and LGA (adjusted OR 0.74, 95% CI 0.61-0.89) after multivariable logistic regression analysis.
CONCLUSIONS/SIGNIFICANCE: The adoption of the IADPSG criteria for diagnosis of GDM was associated with significant reductions in maternal weight gain during pregnancy, birth weights, and the rates of macrosomia and LGA.
2010年，国际糖尿病与妊娠研究组协会（IADPSG）推荐了一种妊娠期糖尿病（GDM）筛查和诊断的新策略。然而，尚无研究表明采用IADPSG的建议能改善围产期结局。本研究的目的是评估实施IADPSG诊断GDM的标准对孕产妇和新生儿结局的影响。
方法/主要发现：此前，我们采用两步法（1小时50克葡萄糖耐量试验，必要时接着进行3小时100克葡萄糖耐量试验）来筛查和诊断GDM。2011年7月，我们在常规产科护理中采用了IADPSG的建议。在本研究中，我们回顾性比较了在IADPSG标准实施之前（P1，2009年1月1日至2010年12月31日）和之后（P2，2012年1月1日至2013年12月31日）所有妊娠24周后分娩的妇女的各种孕产妇和新生儿结局发生率。排除多胎妊娠、胎儿染色体或结构异常以及孕前糖尿病合并的妊娠。我们的结果显示，GDM的发生率从使用两步法时的4.6%增加到使用IADPSG标准时的12.4%。与P1期的妇女相比，P2期的妇女孕期体重增加较少、出生体重较低、产程较短，巨大儿（<4000克）和大于胎龄儿（LGA）的发生率较低。多变量逻辑回归分析后，P2是预防巨大儿（调整优势比[OR]0.63,95%置信区间[CI]0.43 - 0.90）和LGA（调整OR 0.74,95% CI 0.61 - 0.89）的显著独立因素。
结论/意义：采用IADPSG标准诊断GDM与孕期孕产妇体重增加、出生体重以及巨大儿和LGA发生率的显著降低相关。
