Lee Gene T, Satyan Megha Teeka, Grothusen Jill D, Drummond Kelsi M, Hagen Grace, Brown Crystal, Satterwhite Catherine L
a Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology , University of Kansas Medical Center (KUMC) , Kansas City , KS , USA.
b Department of Family Medicine , University of Kansas Medical Center (KUMC) , Kansas City , KS , USA.
J Matern Fetal Neonatal Med. 2019 Jan;32(1):67-72. doi: 10.1080/14767058.2017.1371692. Epub 2017 Sep 6.
More evidence is required to endorse the 1-step approach for gestational diabetes mellitus (GDM) for clinical practice. Since 2010, our department has pragmatically allowed faculty to self-select the guidelines they use to screen and diagnose GDM. We sought to compare the maternal and neonatal outcomes from these two simultaneous cohorts.
We performed a retrospective cohort study of all singleton pregnancies delivered between October 2011 and -November 2013 at our hospital. Patients were excluded if they had preexisting diabetes, were not screened or screened inappropriately, or their fetus had congenital anomalies. Patients were grouped by their screening strategy, and maternal and neonatal outcomes were analyzed.
The 1-step group had a higher incidence of GDM (21.6% versus 5.0%). Initial results suggested higher rates of neonatal hypoglycemia, phototherapy for hyperbilirubinemia, and a lower rate of gestational HTN. After adjustment, these differences disappeared, but a lower rate of large for gestational age (LGA) infants was discovered (adjusted odds ratios (aOR) 0.78).
The picture remains unclear as to whether the 1-step approach is associated with significantly improved outcomes compared with the 2-step approach. We did find a lower risk for a LGA infant in our 1-step cohort, but it is unlikely that the 1-step approach would be cost-effective due to the absence of other improved outcomes.
需要更多证据来支持将一步法用于妊娠期糖尿病（GDM）的临床实践。自2010年以来，我们科室实际允许医务人员自行选择用于筛查和诊断GDM的指南。我们试图比较这两个同时期队列的母婴结局。
我们对2011年10月至2013年11月在我院分娩的所有单胎妊娠进行了一项回顾性队列研究。如果患者有糖尿病病史、未进行筛查或筛查不当，或其胎儿有先天性异常，则将其排除。根据筛查策略对患者进行分组，并分析母婴结局。
一步法组的GDM发病率较高（21.6%对5.0%）。初步结果显示新生儿低血糖、高胆红素血症光疗的发生率较高，妊娠期高血压的发生率较低。调整后，这些差异消失，但发现大于胎龄（LGA）婴儿的发生率较低（调整后的优势比（aOR）为0.78）。
与两步法相比，一步法是否能显著改善结局仍不明确。我们确实在一步法队列中发现LGA婴儿的风险较低，但由于没有其他改善的结局，一步法不太可能具有成本效益。
