Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Obstet Gynaecol. 2022 Aug;42(6):2001-2007. doi: 10.1080/01443615.2022.2068369. Epub 2022 Jun 2.
A total of 1016 pregnant women attending antenatal clinic before 20 weeks of gestation during September 2018 to February 2019 were included in a cohort study with repeated cross-sectional assessments. The study was aimed to determine prevalence and characteristics of gestational diabetes mellitus (GDM) and pregnancy outcomes by early universal screening approach. GDM screening was performed during first visit and repeated during 24-28 weeks of gestation, as necessary, using a 50-g glucose challenge test followed by a 100-g oral glucose tolerance test for GDM diagnosis. Overall prevalence of GDM was 18.6%. A significantly higher prevalence of GDM was observed among high-risk than low-risk women (21.3% vs. 13.1%, = 0.002). GDM among low-risk women contributed to 23.3% of all GDM cases. The majority of GDM (76.2%) were diagnosed before 20 weeks of gestation, with 74.5% occurring in high-risk women and 81.8% occurring in low-risk women. When initial screening tests were normal, risk of GDM diagnosed during 24-28 weeks was 6.0% (7.5% among high-risk women and 3.1% among low-risk women). Compared to those without GDM, women with GDM significantly had lower gestational weight gain ( < 0.001), higher prevalence of preeclampsia ( = 0.001), large for gestational age (LGA) ( = 0.034) and macrosomia ( = 0.004). These outcomes were more pronounced among high-risk women with GDM. Impact Statement Universal GDM screening is recommended during 24-28 weeks of gestation, either by 1- or 2-step approach. Some also recommend early GDM screening among high-risk women. Prevalence of early-onset GDM varies between studies and benefits of early diagnosis and treatment are still controversial. Early universal GDM screening identified more women with GDM and majority could be diagnosed before 20 weeks of gestation. GDM among low-risk women contributed to 23.3% of all cases. Adverse pregnancy outcomes were more common among high-risk women with GDM. This approach could be useful and can be implemented in other settings, especially those that serve high-risk population or with high GDM prevalence. Early universal GDM screening should be considered in settings with high prevalence of GDM and high-risk women. However, benefits of early detection and treatment of GDM should be determined in more details in the future, especially in terms of cost-effectiveness and improvement in pregnancy outcomes.
共有 1016 名孕妇参加了 2018 年 9 月至 2019 年 2 月期间 20 周妊娠前的产前检查，他们参与了一项队列研究，该研究进行了重复的横断面评估。该研究旨在通过早期普遍筛查方法确定妊娠糖尿病（GDM）的患病率和妊娠结局。GDM 筛查在第一次就诊时进行，如果需要，在 24-28 周时进行 50g 葡萄糖挑战试验，然后进行 100g 口服葡萄糖耐量试验以诊断 GDM。GDM 的总患病率为 18.6%。与低危女性相比，高危女性 GDM 的患病率显著更高（21.3%比 13.1%，=0.002）。低危女性的 GDM 占所有 GDM 病例的 23.3%。大多数 GDM（76.2%）在 20 周妊娠前诊断，其中 74.5%发生在高危女性，81.8%发生在低危女性。当初始筛查试验正常时，24-28 周时诊断为 GDM 的风险为 6.0%（高危女性为 7.5%，低危女性为 3.1%）。与无 GDM 的女性相比，患有 GDM 的女性的妊娠体重增加明显较低（<0.001），子痫前期的患病率较高（=0.001），胎儿大小与胎龄的比值（LGA）较大（=0.034）和巨大儿（=0.004）。高危女性中 GDM 的这些结局更为明显。影响说明建议在 24-28 周妊娠时进行 GDM 普遍筛查，无论是 1 步法还是 2 步法。有些人还建议高危女性进行早期 GDM 筛查。早期 GDM 的患病率在不同的研究中有所不同，早期诊断和治疗的益处仍存在争议。早期普遍的 GDM 筛查发现了更多的 GDM 女性，其中大多数可以在 20 周妊娠前诊断。低危女性的 GDM 占所有病例的 23.3%。高危女性 GDM 的不良妊娠结局更为常见。这种方法可能有用，并可在其他环境中实施，尤其是那些为高危人群或 GDM 患病率较高的人群提供服务的环境。在 GDM 患病率高和高危女性中应考虑进行早期普遍的 GDM 筛查。然而，未来应更详细地确定早期发现和治疗 GDM 的益处，特别是在成本效益和改善妊娠结局方面。
