Coetzee Ankia, Hall David R, Conradie Magda
Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Department of Obstetrics and Gynecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Front Clin Diabetes Healthc. 2022 May 24;3:895743. doi: 10.3389/fcdhc.2022.895743. eCollection 2022.
This review contextualizes hyperglycemia in pregnancy from a South-African perspective. It aims to create awareness of the importance of hyperglycemia in pregnancy in low-middle-income countries. We address unanswered questions to guide future research on sub-Saharan African women with hyperglycemia first detected in pregnancy (HFDP). South African women of childbearing age have the highest prevalence of obesity in sub-Saharan Africa. They are predisposed to Type 2 diabetes (T2DM), the leading cause of death in South African women. T2DM remains undiagnosed in many African countries, with two-thirds of people living with diabetes unaware. With the South African health policy's increased focus on improving antenatal care, women often gain access to screening for non-communicable diseases for the first time in pregnancy. While screening practices and diagnostic criteria for gestational diabetes mellitus (GDM) differ amongst geographical areas in South Africa (SA), hyperglycemia of varying degrees is often first detected in pregnancy. This is often erroneously ascribed to GDM, irrespective of the degree of hyperglycemia and not overt diabetes. T2DM and GDM convey a graded increased risk for the mother and fetus during and after pregnancy, with cardiometabolic risk accumulating across the lifespan. Resource limitations and high patient burden have hampered the opportunity to implement accessible preventative care in young women at increased risk of developing T2DM in the broader public health system in SA. All women with HFDP, including those with true GDM, should be followed and undergo glucose assessment postpartum. In SA, studies conducted early postpartum have noted persistent hyperglycemia in a third of women after GDM. Interpregnancy care is advantageous and may attain a favourable metabolic legacy in these young women, but the yield of return following delivery is suboptimal. We review the current best evidence regarding HFDP and contextualize the applicability in SA and other African or low-middle-income countries. The review identifies gaps and shares pragmatic solutions regarding clinical factors that may improve awareness, identification, diagnosis, and management of women with HFDP.
本综述从南非的视角探讨了妊娠期间的高血糖问题。其目的是提高人们对中低收入国家妊娠期间高血糖重要性的认识。我们解决了一些未解答的问题，以指导未来对妊娠期间首次检测出血糖高的撒哈拉以南非洲女性（妊娠期间首次检测出血糖高）的研究。南非育龄女性的肥胖率在撒哈拉以南非洲地区最高。她们易患2型糖尿病（T2DM），这是南非女性的主要死因。在许多非洲国家，T2DM仍未得到诊断，三分之二的糖尿病患者 unaware。随着南非卫生政策越来越关注改善产前护理，女性在孕期往往首次能够接受非传染性疾病筛查。虽然南非不同地理区域的妊娠期糖尿病（GDM）筛查方法和诊断标准有所不同，但不同程度的高血糖往往是在孕期首次被检测到。这常常被错误地归因于GDM，而不考虑高血糖的程度以及是否为显性糖尿病。T2DM和GDM在孕期及产后会使母亲和胎儿面临的风险逐渐增加，心脏代谢风险会在整个生命周期中不断累积。资源限制和患者负担过重阻碍了在南非更广泛的公共卫生系统中，为患T2DM风险增加的年轻女性实施可及的预防护理的机会。所有妊娠期间首次检测出血糖高的女性，包括那些真正患有GDM的女性，都应在产后接受随访并进行血糖评估。在南非，产后早期进行的研究发现，三分之一的GDM女性产后仍存在持续性高血糖。孕期间隔护理具有优势，可能会让这些年轻女性获得良好的代谢遗产，但产后的收益并不理想。我们回顾了关于妊娠期间首次检测出血糖高的当前最佳证据，并阐述了其在南非以及其他非洲或中低收入国家的适用性。本综述指出了差距，并分享了关于临床因素的实用解决方案，这些因素可能有助于提高对妊娠期间首次检测出血糖高的女性的认识、识别、诊断和管理水平。
