Simmons David, Gupta Yashdeep, Hernandez Teri L, Levitt Naomi, van Poppel Mireille, Yang Xilin, Zarowsky Christina, Backman Helena, Feghali Maisa, Nielsen Karoline Kragelund
School of Medicine, Western Sydney University, Sydney, NSW, Australia.
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
Lancet. 2024 Jul 13;404(10448):193-214. doi: 10.1016/S0140-6736(24)00826-2. Epub 2024 Jun 20.
Gestational diabetes remains the most common medical disorder in pregnancy, with short-term and long-term consequences for mothers and offspring. New insights into pathophysiology and management suggest that the current gestational diabetes treatment approach should expand from a focus on late gestational diabetes to a personalised, integrated life course approach from preconception to postpartum and beyond. Early pregnancy lifestyle intervention could prevent late gestational diabetes. Early gestational diabetes diagnosis and treatment has been shown to be beneficial, especially when identified before 14 weeks of gestation. Early gestational diabetes screening now requires strategies for integration into routine antenatal care, alongside efforts to reduce variation in gestational diabetes care, across settings that differ between, and within, countries. Following gestational diabetes, an oral glucose tolerance test should be performed 6-12 weeks postpartum to assess the glycaemic state. Subsequent regular screening for both dysglycaemia and cardiometabolic disease is recommended, which can be incorporated alongside other family health activities. Diabetes prevention programmes for women with previous gestational diabetes might be enhanced using shared decision making and precision medicine. At all stages in this life course approach, across both high-resource and low-resource settings, a more systematic process for identifying and overcoming barriers to preventative care and treatment is needed to reduce the current global burden of gestational diabetes.
妊娠期糖尿病仍然是孕期最常见的医学病症，对母亲和后代都有短期和长期影响。对病理生理学和管理的新见解表明，当前的妊娠期糖尿病治疗方法应从专注于妊娠晚期糖尿病扩展为从孕前到产后及更长期的个性化、综合的生命历程方法。孕早期生活方式干预可预防妊娠晚期糖尿病。妊娠早期糖尿病的诊断和治疗已被证明是有益的，尤其是在妊娠14周前确诊时。现在，早期妊娠糖尿病筛查需要将相关策略纳入常规产前护理，同时努力减少各国之间及国内不同地区妊娠期糖尿病护理的差异。妊娠糖尿病之后，应在产后6至12周进行口服葡萄糖耐量试验，以评估血糖状态。建议随后定期筛查血糖异常和心脏代谢疾病，这可以与其他家庭健康活动相结合。对于既往有妊娠糖尿病的女性，可通过共同决策和精准医学来加强糖尿病预防计划。在这个生命历程方法的所有阶段，无论在高资源还是低资源环境中，都需要一个更系统的过程来识别和克服预防保健和治疗的障碍，以减轻当前全球妊娠期糖尿病的负担。
