妊娠期糖尿病早期和普遍筛查的理由：来自尼日利亚一个大城市9314名孕妇的研究结果
The Case for Early and Universal Screening for Gestational Diabetes Mellitus: Findings from 9314 Pregnant Women in a Major City in Nigeria.
作者信息
Ogu Rosemary, Maduka Omosivie, Agala Vetty, Obuah Precious, Horsfall Faithwin, Azi Esther, Nwibubasa Cecilia, Edewor Ufuoma, Porbeni Ibimonye, John Osita, Orazulike Ngozi, Kalio Dango, Okagua Kenneth, Edet Clement, Harry Agiriye, Ugboma Henry, Abam Claribel
机构信息
Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Nigeria.
Medical Women's Association of Nigeria, Rivers State Branch, Port Harcourt, Nigeria.
出版信息
Diabetes Ther. 2022 Oct;13(10):1769-1778. doi: 10.1007/s13300-022-01307-y. Epub 2022 Aug 25.
INTRODUCTION
Risk-based screening has been replaced by universal screening as the recommended course of care for gestational diabetes mellitus (GDM). As of 2016, no state in Nigeria had implemented a policy of universal screening for GDM. This research aimed to assess findings from a universal screening programme and its implication for scaling up universal and early screening for GDM.
METHODS
This was a descriptive cross-sectional study conducted in Rivers State Nigeria between February 2017 and January 2020. Multistage sampling was used to recruit 9314 pregnant women from 30 primary, secondary, and tertiary health facilities in the state. An interviewer-administered structured questionnaire was used by trained healthcare workers to collect socio-demographic, obstetric and medical information. All study participants had a plasma glucose test on their first hospital visit and a diagnosis made using the World Health Organization (WHO) criteria. Data obtained was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 23.
RESULTS
Most women [5683 (61.0%)] were aged 25-34 (mean 29.60 ± 5.64) years. The prevalence of GDM in this study was 5.2% with a prevalence of GDM in the first, second and third trimesters of 4.9%, 4.2% and 6.7%, respectively. The prevalence of GDM among persons with a family history of diabetes was 13.2% (97 persons) while 4.6% (391 persons) without family history were diagnosed with GDM. Gestational age, family history of diabetes and age group were found to be significant predictors of GDM among the study participants after adjusting for confounding variables.
CONCLUSION
The practice of universal screening was useful in identifying GDM in 1 out of 20 pregnant women in the study sample. Screening at all trimesters was useful in identifying GDM. There is an urgent need to scale up early and universal screening for GDM across sub-Saharan Africa.
引言
基于风险的筛查已被普遍筛查所取代，成为妊娠期糖尿病（GDM）推荐的护理方式。截至2016年，尼日利亚没有一个州实施GDM普遍筛查政策。本研究旨在评估一项普遍筛查计划的结果及其对扩大GDM普遍和早期筛查的意义。
方法
这是一项描述性横断面研究，于2017年2月至2020年1月在尼日利亚河流州进行。采用多阶段抽样从该州30家初级、二级和三级卫生设施招募了9314名孕妇。经过培训的医护人员使用访谈式结构化问卷收集社会人口学、产科和医疗信息。所有研究参与者在首次就诊时进行血浆葡萄糖检测，并根据世界卫生组织（WHO）标准进行诊断。使用IBM社会科学统计软件包（SPSS）23版对获得的数据进行分析。
结果
大多数女性[5683名（61.0%）]年龄在25 - 34岁（平均29.60±5.64岁）。本研究中GDM的患病率为5.2%，妊娠第一、第二和第三孕期的GDM患病率分别为4.9%、4.2%和6.7%。有糖尿病家族史者中GDM患病率为13.2%（97人），无家族史者中4.6%（391人）被诊断为GDM。在调整混杂变量后，发现妊娠年龄、糖尿病家族史和年龄组是研究参与者中GDM的重要预测因素。
结论
普遍筛查的做法有助于在研究样本中每20名孕妇中识别出1例GDM。在所有孕期进行筛查有助于识别GDM。迫切需要在撒哈拉以南非洲扩大GDM的早期和普遍筛查。
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