采用 2013 年世界卫生组织妊娠期糖尿病诊断标准对多民族亚洲队列的影响：一项前瞻性研究。
Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study.
机构信息
Department of Obstetrics & Gynaecology, National University Hospital, Singapore, 119074, Singapore.
Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, 229899, Singapore.
出版信息
BMC Pregnancy Childbirth. 2018 Mar 21;18(1):69. doi: 10.1186/s12884-018-1707-3.
BACKGROUND
We assessed the impact of adopting the 2013 World Health Organization (WHO) diagnostic criteria on the rates of gestational diabetes (GDM), pregnancy outcomes and identification of women at future risk of type 2 diabetes.
METHODS
During a period when the 1999 WHO GDM criteria were in effect, pregnant women were universally screened using a one-step 75 g 2-h oral glucose tolerance test at 26-28 weeks' gestation. Women were retrospectively reclassified according to the 2013 criteria, but without the 1-h glycaemia measurement. Pregnancy outcomes and glucose tolerance at 4-5 years post-delivery were compared for women with GDM classified by the 1999 criteria alone, GDM by the 2013 criteria alone, GDM by both criteria and without GDM by both sets of criteria.
RESULTS
Of 1092 women, 204 (18.7%) and 142 (13.0%) were diagnosed with GDM by the 1999 and 2013 WHO criteria, respectively, with 27 (2.5%) reclassified to GDM and 89 (8.2%) reclassified to non-GDM when shifting from the 1999 to 2013 criteria. Compared to women without GDM by both criteria, cases reclassified to GDM by the 2013 criteria had an increased risk of neonatal jaundice requiring phototherapy (relative risk (RR) = 2.78, 95% confidence interval (CI) 1.32, 5.86); despite receiving treatment for GDM, cases reclassified to non-GDM by the 2013 criteria had higher risks of prematurity (RR = 2.17, 95% CI 1.12, 4.24), neonatal hypoglycaemia (RR = 3.42, 95% CI 1.04, 11.29), jaundice requiring phototherapy (RR = 1.71, 95% CI 1.04, 2.82), and a higher rate of abnormal glucose tolerance at 4-5 years post-delivery (RR = 3.39, 95% CI 2.30, 5.00).
CONCLUSIONS
Adoption of the 2013 WHO criteria, without the 1-h glycaemia measurement, reduced the GDM rate. Lowering the fasting glucose threshold identified women who might benefit from treatment, but raising the 2-h threshold may fail to identify women at increased risk of adverse pregnancy and future metabolic outcomes.
TRIAL REGISTRATION
NCT01174875 . Registered 1 July 2010 (retrospectively registered).
背景
我们评估了采用 2013 年世界卫生组织（WHO）诊断标准对妊娠糖尿病（GDM）发生率、妊娠结局以及识别未来 2 型糖尿病风险女性的影响。
方法
在 1999 年 WHO GDM 标准生效期间，所有孕妇在 26-28 孕周时均采用一步法 75g 2 小时口服葡萄糖耐量试验进行普遍筛查。根据 2013 年标准对女性进行回顾性重新分类，但不包括 1 小时血糖测量。比较仅根据 1999 年标准、仅根据 2013 年标准、同时根据两项标准分类为 GDM 以及两项标准均不分类为 GDM 的女性的妊娠结局和产后 4-5 年的葡萄糖耐量。
结果
在 1092 名女性中，分别有 204 名（18.7%）和 142 名（13.0%）女性被 1999 年和 2013 年 WHO 标准诊断为 GDM，其中 27 名（2.5%）被重新分类为 GDM，89 名（8.2%）被重新分类为非 GDM，当从 1999 年标准转换为 2013 年标准时。与两项标准均无 GDM 的女性相比，根据 2013 年标准重新分类为 GDM 的病例发生新生儿黄疸需要光疗的风险增加（相对风险（RR）=2.78，95%置信区间（CI）1.32-5.86）；尽管接受了 GDM 治疗，但根据 2013 年标准重新分类为非 GDM 的病例早产（RR=2.17，95%CI 1.12-4.24）、新生儿低血糖（RR=3.42，95%CI 1.04-11.29）、黄疸需要光疗（RR=1.71，95%CI 1.04-2.82）以及产后 4-5 年葡萄糖耐量异常的发生率更高（RR=3.39，95%CI 2.30-5.00）。
结论
采用 2013 年 WHO 标准，不包括 1 小时血糖测量，降低了 GDM 发生率。降低空腹血糖阈值可识别可能受益于治疗的女性，但提高 2 小时阈值可能无法识别有妊娠和未来代谢不良结局风险增加的女性。
试验注册
NCT01174875。2010 年 7 月 1 日注册（ retrospectively registered）。
Zotero 插件