Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN, USA.
Macarthur Clinical School, Western Sydney University, Sydney, Australia.
Diabet Med. 2019 Feb;36(2):142-150. doi: 10.1111/dme.13772. Epub 2018 Jul 9.
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse outcomes for mother and infant both at birth and later in life. A large body of evidence is now available relating to antenatal prevention of GDM. Overall, despite some individual trials of a variety of lifestyle interventions revealing benefit, many more have shown no effect from the second trimester onwards, even with significant gestational weight gain limitation. At-risk women often seem reluctant to engage in lifestyle changes and frequently cannot adhere to recommended interventions even within a clinical trial setting. Many trials have not considered the heterogeneity of diabetes first discovered in pregnancy, something of importance into the future. Future work should focus on designing interventions acceptable to the population at risk, whether those taking place before or during the first trimester of pregnancy are effective, and whether greater individualization can identify those women most likely to benefit.
妊娠期糖尿病（GDM）与母婴在出生时和以后的生活中出现不良结局的风险增加有关。现在有大量证据表明可以在产前预防 GDM。总的来说，尽管一些针对各种生活方式干预的个体试验显示出了益处，但从孕中期开始，许多试验显示没有效果，即使限制了明显的妊娠期体重增加。高危妇女似乎往往不愿意改变生活方式，即使在临床试验环境中，也经常无法坚持推荐的干预措施。许多试验没有考虑到在妊娠期间首次发现的糖尿病的异质性，这是未来的重要问题。未来的工作应侧重于设计对高危人群可接受的干预措施，无论这些干预措施是在妊娠前还是在妊娠早期进行，以及是否可以更加个体化，以确定最有可能受益的女性。
