Koivunen Sanna, Torkki Annukka, Bloigu Aini, Gissler Mika, Pouta Anneli, Kajantie Eero, Vääräsmäki Marja
Department of Obstetrics and Gynecology and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Child and Adolescent Health and Wellbeing Unit, National Institute for Health and Welfare, Oulu, Finland.
Acta Obstet Gynecol Scand. 2017 Jan;96(1):106-113. doi: 10.1111/aogs.13030. Epub 2016 Nov 22.
The change from risk-factor-based to nearly comprehensive screening of gestational diabetes (GDM) identifies more but milder cases of the disease. The main aim of this study was to evaluate the effect of this screening policy change on neonatal outcomes and care.
A population-based register study in Finland. GDM cases during risk-factor-based (year 2006, n = 5179) and comprehensive (2010, n = 6679) screenings were identified through the Medical Birth Register. All singletons without maternal GDM or prepregnancy diabetes served as controls (n = 51 746 and n = 52 386, respectively). The main outcomes were macrosomia, neonatal hypoglycemia and the need for care in a neonatal ward.
In the GDM group, the mean birthweight decreased between the study years from 3660 g to 3595 g and the prevalence of macrosomia from 5.6 to 4.1% even after adjustment for maternal age, parity and prepregnancy body mass index. The adjusted mean difference in birthweight between GDM and control newborns decreased from 70 to 22 g between the study years. The prevalence of neonatal hypoglycemia increased from 18.0 to 22.1% in the GDM group. However, neonatal hypoglycemia was more often treated without care in a neonatal ward. The proportion of infants treated on a neonatal ward decreased in both the GDM and control groups between the study years.
In newborns, comprehensive GDM screening led to decreased mean birthweight and macrosomia rates, but the prevalence of neonatal hypoglycemia increased. This places substantial demands for delivery hospitals and healthcare resources.
从基于风险因素的筛查转变为几乎全面的妊娠期糖尿病（GDM）筛查，发现了更多但病情较轻的病例。本研究的主要目的是评估这种筛查政策变化对新生儿结局和护理的影响。
在芬兰进行的一项基于人群的登记研究。通过医疗出生登记册确定基于风险因素筛查（2006年，n = 5179）和全面筛查（2010年，n = 6679）期间的GDM病例。所有无母体GDM或孕前糖尿病的单胎作为对照（分别为n = 51746和n = 52386）。主要结局为巨大儿、新生儿低血糖以及新生儿病房护理需求。
在GDM组中，即使在调整了产妇年龄、产次和孕前体重指数后，研究年份之间的平均出生体重从3660克降至3595克，巨大儿患病率从5.6%降至4.1%。研究年份之间，GDM与对照新生儿出生体重的调整后平均差异从70克降至22克。GDM组新生儿低血糖患病率从18.0%增至22.1%。然而，新生儿低血糖更多是在无需新生儿病房护理的情况下得到治疗。研究年份之间，GDM组和对照组在新生儿病房接受治疗的婴儿比例均有所下降。
对于新生儿，全面的GDM筛查导致平均出生体重和巨大儿发生率降低，但新生儿低血糖患病率增加。这对分娩医院和医疗资源提出了巨大需求。
