Huhn Evelyn A, Massaro Nadine, Streckeisen Simone, Manegold-Brauer Gwendolin, Schoetzau Andreas, Schulzke Sven M, Winzeler Bettina, Hoesli Irene, Lapaire Olav
Department of Obstetrics and Gynaecology, University Hospital Basel, Spitalstrasse 21, 4031 Basel.
Department of Surgery, Hospital Dornach, Dornach.
J Perinat Med. 2017 Apr 1;45(3):359-366. doi: 10.1515/jpm-2016-0099.
The aim was to evaluate the influence of the new International Association of Diabetes and Pregnancy Study Groups (IADPSG) guidelines for screening of gestational diabetes mellitus (GDM) on GDM prevalence in a cohort from a Swiss tertiary hospital.
This was a retrospective cohort study involving all pregnant women who were screened for GDM between 24 and 28 weeks of gestation. From 2008 until 2010 (period 1), a two-step approach with 1-h 50 g glucose challenge test (GCT) was used, followed by fasting, 1- and 2-h glucose measurements after a 75 g oral glucose tolerance test (OGTT) in case of a positive GCT. From 2010 until 2013 (period 2), all pregnant women were tested with a one-step 75 g OGTT according to new IADPSG guidelines. In both periods, women with risk factors could be screened directly with a 75 g OGTT in early pregnancy.
Overall, 647 women were eligible for the study in period 1 and 720 in period 2. The introduction of the IADPSG criteria resulted in an absolute increase of GDM prevalence of 8.5% (3.3% in period 1 to 11.8% in period 2).
The adoption of the IADPSG criteria resulted in a considerable increase in GDM diagnosis in our Swiss cohort. Further studies are needed to investigate if the screening is cost effective and if treatment of our additionally diagnosed GDM mothers might improve short-term as well as long-term outcome.
目的是评估国际糖尿病与妊娠研究组（IADPSG）关于妊娠期糖尿病（GDM）筛查的新指南对瑞士一家三级医院队列中GDM患病率的影响。
这是一项回顾性队列研究，纳入了所有在妊娠24至28周期间接受GDM筛查的孕妇。从2008年至2010年（第1阶段），采用两步法，即进行1小时50克葡萄糖耐量试验（GCT），若GCT结果为阳性，则随后进行空腹、口服75克葡萄糖耐量试验（OGTT）后1小时和2小时的血糖测量。从2010年至2013年（第2阶段），根据IADPSG新指南，所有孕妇均采用一步法75克OGTT进行检测。在两个阶段中，有危险因素的女性在孕早期可直接进行75克OGTT筛查。
总体而言，第1阶段有647名女性符合研究条件，第2阶段有720名。采用IADPSG标准导致GDM患病率绝对增加了8.5%（从第1阶段的3.3%增至第2阶段的11.8%）。
采用IADPSG标准使我们瑞士队列中的GDM诊断率大幅增加。需要进一步研究来调查这种筛查是否具有成本效益，以及对我们额外诊断出的GDM母亲进行治疗是否可能改善短期和长期结局。
