Departments of Obstetrics and Gynecology, Kaiser Permanente at Baldwin Park, Montebello, and Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, and the Department of Research and Evaluation, Kaiser Permanente, Pasadena, California.
Obstet Gynecol. 2016 Jan;127(1):10-17. doi: 10.1097/AOG.0000000000001132.
To evaluate whether one-step gestational diabetes screening recommended by The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) is associated with better maternal, perinatal, or neonatal outcomes than the two-step Carpenter-Coustan screening.
In this before-after retrospective cohort study conducted between July 1, 2010, and December 31, 2013, we compared Carpenter-Coustan and IADPSG screening in patients with singleton pregnancies. All patients diagnosed with gestational diabetes received intensive teaching, home glucose monitoring, and medications as indicated. The primary outcome was the rate of large-for-gestational-age neonates. Secondary outcome measures were macrosomia (greater than 4,000 g), primary cesarean delivery, neonatal intensive care unit admission, preterm delivery, preeclampsia, and hyperbilirubinemia. We determined that a sample size of 2,782 per group was sufficient to detect a 2% difference in the primary outcome between groups with 80% power assuming a 10% incidence in the before group. The groups were compared using Fisher exact test for proportions and a χ test for odds ratios.
In the before (Carpenter-Coustan) group, 513 (17%) of the 2,972 patients were diagnosed with gestational diabetes, and in the after (IADPSG) group, 847 (27%) of the 3,094 patients were so diagnosed (P<.001). There was no significant difference in rates of large for gestational age, 10% and 9%, respectively (P=.25). The IADPSG group had a significantly higher primary cesarean delivery rate-16% compared with 20% (P<.001), but there were no significant differences in any other pregnancy outcomes.
Although one-step screening was associated with more patients being treated for gestational diabetes, it was not associated with a decrease in large-for-gestational-age or macrosomic neonates but was associated with an increased rate of primary cesarean delivery. Our results did not support the IADPSG-recommended screening protocol.
评估国际妊娠合并糖尿病研究组织（IADPSG）推荐的一步法妊娠糖尿病筛查是否比两步法 Carpenter-Coustan 筛查更有利于母婴、围产儿或新生儿结局。
本项于 2010 年 7 月 1 日至 2013 年 12 月 31 日进行的前后回顾性队列研究，比较了单胎妊娠患者的 Carpenter-Coustan 和 IADPSG 筛查。所有诊断为妊娠糖尿病的患者均接受强化教育、家庭血糖监测和有指征的药物治疗。主要结局为巨大儿（大于 4000g）的发生率。次要结局指标包括巨大儿（大于 4000g）、初次剖宫产、新生儿重症监护病房入院、早产、子痫前期和高胆红素血症。我们确定每组 2782 例的样本量足以在组间检测到主要结局 2%的差异，效能为 80%，假设前组发生率为 10%。使用 Fisher 确切检验和卡方检验比较组间差异。
在前组（Carpenter-Coustan）中，2972 例患者中有 513 例（17%）被诊断为妊娠糖尿病，在后组（IADPSG）中，3094 例患者中有 847 例（27%）被诊断为妊娠糖尿病（P<.001）。巨大儿的发生率分别为 10%和 9%，差异无统计学意义（P=.25）。IADPSG 组初次剖宫产率明显更高-16%比 20%（P<.001），但其他妊娠结局无显著差异。
虽然一步法筛查与更多的妊娠糖尿病患者接受治疗有关，但与巨大儿或巨大儿的发生率降低无关，但与初次剖宫产率的增加有关。我们的结果不支持 IADPSG 推荐的筛查方案。
