Ellenberg Anni, Sarvilinna Nanna, Gissler Mika, Ulander Veli-Matti
Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
National Institute for Health and Welfare, Helsinki, Finland.
Acta Obstet Gynecol Scand. 2017 Mar;96(3):372-381. doi: 10.1111/aogs.13074. Epub 2017 Jan 18.
In this study, we have assessed the changes in pregnancy outcomes following the implementation of national guidelines for gestational diabetes mellitus (GDM). These national guidelines changed the screening policy from risk-based to comprehensive screening.
We designed a retrospective register-based cohort study based on the data from the Finnish Medical Birth Register and Hospital Discharge Register including 34 794 singleton births in 2006-2008 and 36 488 in 2010-2012. Maternal characteristics and pregnancy outcomes were analyzed.
Overall, 29.6% of mothers underwent an oral glucose tolerance test in 2006-2008 compared with 59.7% in 2010-2012. The prevalence of GDM increased from 7.2 to 11.3% and was highest among obese women (body mass index ≥30 kg/m ) (from 30.0 to 34.7%; p < 0.001). The proportion of insulin-treated women remained unchanged (12.5/12.3%; p = 0.70). The main pregnancy outcomes for the women with GDM were the increased usage of oxytocin (19.5/40.0%, p < 0.001), increased number of inductions (27.2/33.0%; p < 0.001) and reduced birthweight (mean ± SD: 3647 ± 575 g/3567 ± 575 g). Healthy and unscreened women displayed similar results. Children of both women with GDM and healthy screened women had fewer admissions to the neonatal intensive care unit (16.3%/12.1%; p < 0.001) and less asphyxia (11.3%/6.3%; p < 0.001). However, the rates of cesarean delivery (26.5%/25.4%, p = 0.31), resuscitation (2.6%/2.0%; p = 0.12), and perinatal mortality (1.2‰/3.1‰, p = 0.11) among women with GDM did not change, whereas the number of hypoglycemia cases increased (2.3%/5.2%; p < 0.001).
In conclusion, glucose tolerance tests were performed twice as often as a result of the implementation of the national GDM guidelines, but this comprehensive screening practice did not improve pregnancy and neonatal outcomes.
在本研究中，我们评估了实施国家妊娠期糖尿病（GDM）指南后妊娠结局的变化。这些国家指南将筛查政策从基于风险的筛查改为全面筛查。
我们基于芬兰医疗出生登记册和医院出院登记册的数据设计了一项回顾性队列研究，涵盖2006 - 2008年的34794例单胎分娩以及2010 - 2012年的36488例单胎分娩。对产妇特征和妊娠结局进行了分析。
总体而言，2006 - 2008年有29.6%的母亲接受了口服葡萄糖耐量试验，而2010 - 2012年这一比例为59.7%。GDM的患病率从7.2%升至11.3%，在肥胖女性（体重指数≥30 kg/m²）中最高（从30.0%升至34.7%；p < 0.001）。接受胰岛素治疗的女性比例保持不变（12.5%/12.3%；p = 0.70）。GDM女性的主要妊娠结局包括催产素使用增加（19.5%/40.0%，p < 0.001）、引产次数增加（27.2%/33.0%；p < 0.001）以及出生体重降低（均值±标准差：3647 ± 575 g/3567 ± 575 g）。健康且未接受筛查的女性呈现出类似结果。GDM女性和健康接受筛查女性的孩子入住新生儿重症监护病房的情况较少（16.3%/12.1%；p < 0.001）且窒息情况较少（11.3%/6.3%；p < 0.001）。然而，GDM女性的剖宫产率（26.5%/25.4%，p = 0.31）、复苏率（2.6%/2.0%；p = 0.12）和围产儿死亡率（1.2‰/3.1‰，p = 0.11）没有变化，而低血糖病例数增加（2.3%/5.2%；p < 0.001）。
总之，由于实施国家GDM指南，葡萄糖耐量试验的执行频率增加了一倍，但这种全面筛查做法并未改善妊娠和新生儿结局。
