Unit of Obstetrics and Gynecology, Department of Medical and Surgical Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
Department of Health Sciences, University "Magna Græcia" of Catanzaro, Viale Europa, 88100 Catanzaro, Italy.
J Diabetes Res. 2020 Sep 18;2020:5393952. doi: 10.1155/2020/5393952. eCollection 2020.
Screening strategies for gestational diabetes mellitus (GDM) earlier than 24-28 weeks of gestation should be considered to prevent adverse pregnancy outcomes. Nonetheless, there is uncertainty about which women would benefit most from early screening and which screening strategies should be offered to women with GDM. The Italian National Healthcare Service (NHS) recommendations on selective screening for GDM at 16-18 weeks of gestation are effective in preventing fetal macrosomia in high-risk (HR) women, but the appropriateness of timing and effectiveness of these recommendations in medium- (MR) and low-risk (LR) women are still controversial. . We retrospectively enrolled 769 consecutive singleton pregnant women who underwent both anomaly scan at 19-21 weeks of gestation and screening for GDM at 16-18 and/or 24-28 weeks of gestation, in agreement with the NHS recommendations and risk stratification criteria. Comparison of maternal characteristics, fetal biometric parameters at anomaly scan (head circumference (HC), biparietal diameter (BPD), abdominal circumference (AC), femur length (FL), estimated fetal weight (EFW)), and neonatal birth weight (BW) percentile among risk groups was examined.
219 (28.5%) women were diagnosed with GDM, while 550 (71.5%) were normal glucose-tolerant women. Out of 164 HR women, only 62 (37.8%) underwent the recommended early screening for GDM at 16-18 weeks of gestation. AC and EFW percentiles, as well as neonates' BW percentiles, were significantly higher in HR women diagnosed with GDM at 24-28 weeks of gestation with respect to normal glucose-tolerant women, as well as MR and LR women who tested positive for GDM. Comparative analysis between MR and LR women with GDM and women with normal glucose tolerance revealed significant differences in both AC and EFW percentiles ( < 0.05), while there was no significant difference in neonatal BW percentiles.
In MR and LR women with GDM, a mild acceleration of fetal growth can be detected at the time of anomaly scan. However, in these at-risk categories, the NHS recommendations for screening and treatment of GDM at 24-28 weeks of gestation are still effective in normalizing BW and preventing fetal macrosomia, thus supporting a risk factor-based selective screening program for GDM.
应考虑在 24-28 孕周之前实施妊娠期糖尿病（GDM）筛查策略，以预防不良妊娠结局。然而，对于哪些女性最能从早期筛查中获益，以及应该向 GDM 女性提供哪些筛查策略，仍存在不确定性。意大利国家医疗保健服务（NHS）建议在 16-18 孕周时选择性筛查 GDM，这一建议在高风险（HR）女性中可有效预防胎儿巨大儿，但在中风险（MR）和低风险（LR）女性中，该建议的时机和效果仍存在争议。我们回顾性纳入了 769 例连续的单胎妊娠女性，这些女性均在 19-21 孕周时接受了异常扫描，并在 16-18 孕周和/或 24-28 孕周时接受了 GDM 筛查，这符合 NHS 建议和风险分层标准。比较了不同风险组间的母体特征、异常扫描时的胎儿生物测量参数（头围（HC）、双顶径（BPD）、腹围（AC）、股骨长（FL）、估计胎儿体重（EFW））和新生儿出生体重（BW）百分位。结果：219 例（28.5%）女性被诊断为 GDM，550 例（71.5%）为正常糖耐量女性。在 164 例 HR 女性中，仅有 62 例（37.8%）在 16-18 孕周时接受了推荐的早期 GDM 筛查。与正常糖耐量女性以及在 24-28 孕周时被诊断为 GDM 的 MR 和 LR 女性相比，在 24-28 孕周时被诊断为 GDM 的 HR 女性的 AC 和 EFW 百分位以及新生儿 BW 百分位明显更高。与正常糖耐量女性相比，MR 和 LR 女性中被诊断为 GDM 的女性的 AC 和 EFW 百分位存在显著差异（<0.05），而新生儿 BW 百分位则无显著差异。结论：在 MR 和 LR 女性中，在进行异常扫描时可发现胎儿生长轻度加速。然而，在这些高危人群中，在 24-28 孕周时进行 GDM 的 NHS 筛查和治疗建议仍可有效使 BW 正常化并预防胎儿巨大儿，因此支持基于危险因素的 GDM 选择性筛查方案。
