Ferreira Ana Filipa, Silva Catarina Miranda, Antunes Dora, Sousa Filipa, Lobo António Carlos, Moura Paulo
Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra.; Faculdade de Medicina da Universidade de Coimbra. Coimbra.
Serviço de Obstetrícia A. Maternidade Daniel de Matos. Centro Hospitalar e Universitário de Coimbra. Coimbra. Faculdade de Medicina da Universidade de Coimbra. Coimbra. Portugal.
Acta Med Port. 2018 Aug 31;31(7-8):416-424. doi: 10.20344/amp.10135.
There is no international consensus regarding gestational diabetes mellitus diagnostic criteria. In Portugal, the Carpenter and Coustan criteria were replaced by an adaptation of the International Association of Diabetes and Pregnancy Study Groups criteria. Our aim was to compare the incidence and outcomes of pregnancies complicated by gestational diabetes mellitus according to the current and previous criteria.
Retrospective analysis of 1218 singleton pregnancies complicated with gestational diabetes mellitus, with surveillance/delivery between 2008-2015. Two groups were considered: identification according to the Directorate-General of Health criteria - International Association of Diabetes and Pregnancy Study Groups (group 1); identification through Carpenter and Coustan criteria (group 2). A comparative analysis was performed.
The incidence of gestational diabetes mellitus doubled (9.4% vs 4.6%), and the number of consultations/year increased (~3000 vs ~2000). In Group 1, in comparison with group 2, there was a lower risk of macrosomia in newborns [RR 0.44 (IC (95%):0.26 - 0.76)] and a higher risk of small for gestational age infants [RR 1.99 (IC (95%):1.19 - 3.31)]; a 6 - fold and 4 fold higher risk in neonatal hypoglycemia [RR 6.30 (IC (95%): 3.39 - 11.71)] and hyperbilirubinemia [RR 3.89 (IC (95%): 2.25 - 6.72)] were also observed, respectively. There were no differences regarding other outcomes.
Outcomes related to the decrease in macrosomia did now show any improvement, with even an increase in Small for Gestational Age and neonatal complications. Given the increased incidence of gestational diabetes mellitus, Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria may be associated with greater healthcare-related costs due to more frequent consultations, with no apparent obstetrical/neonatal benefit.
The Directorate-General of Health - International Association of Diabetes and Pregnancy Study Groups criteria were associated with a decrease in macrosomia, not accompanied by an improvement of obstetrical/perinatal outcomes. The benefit of using these criteria is open to debate.
关于妊娠期糖尿病的诊断标准，目前尚无国际共识。在葡萄牙，卡彭特和库斯坦标准已被国际糖尿病与妊娠研究组标准的改编版本所取代。我们的目的是比较根据当前和先前标准诊断的妊娠期糖尿病合并妊娠的发生率和结局。
对2008年至2015年间1218例单胎妊娠合并妊娠期糖尿病且接受监测/分娩的病例进行回顾性分析。分为两组：根据葡萄牙卫生部标准 - 国际糖尿病与妊娠研究组标准进行诊断的为第一组；通过卡彭特和库斯坦标准进行诊断的为第二组。进行了对比分析。
妊娠期糖尿病的发生率翻倍（9.4%对4.6%），每年的会诊次数增加（约3000次对约2000次）。与第二组相比，第一组新生儿巨大儿风险较低[相对危险度0.44（95%置信区间：0.26 - 0.76）]，小于胎龄儿风险较高[相对危险度1.99（95%置信区间：1.19 - 3.31）]；新生儿低血糖[相对危险度6.30（95%置信区间：3.39 - 11.71）]和高胆红素血症[相对危险度3.89（95%置信区间：2.25 - 6.72）]的风险分别高出6倍和4倍。其他结局方面无差异。
与巨大儿减少相关的结局并未显示出任何改善，甚至小于胎龄儿和新生儿并发症有所增加。鉴于妊娠期糖尿病发生率的上升，葡萄牙卫生部 - 国际糖尿病与妊娠研究组标准可能因会诊更频繁而导致与医疗保健相关的成本增加，且未带来明显的产科/新生儿益处。
葡萄牙卫生部 - 国际糖尿病与妊娠研究组标准与巨大儿减少相关，但并未改善产科/围产期结局。使用这些标准的益处尚有待探讨。
