Liggins Institute, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
BMC Pregnancy Childbirth. 2024 Nov 4;24(1):720. doi: 10.1186/s12884-024-06899-w.
Gestational diabetes mellitus (GDM) is the most common metabolic disorder in pregnancy and later is associated with an increased risk of type 2 diabetes and other metabolic disorders. Consistent and evidence based postnatal care is key to improving maternal long-term health. We therefore aimed to review and compare recommendations of national and international clinical practice guidelines (CPG) for postnatal care after GDM and identify any evidence gaps in recommendations needing further research.
We searched five databases and forty professional organization websites for CPGs providing recommendations for postnatal care after GDM. CPGs which had full versions in English, endorsed, prepared, or authorized by a professional body, and published between 2013 and 2023 were eligible for inclusion. Two reviewers independently screened the articles, extracted the recommendations, and appraised the included CPGs using the Appraisal of Guidelines, Research, and Evaluation (AGREE) II tool.
Twenty-six CPGs from 22 countries were included. Twelve CPGs (46%) were appraised as low quality with the lowest scoring domains being rigor of development and editorial independence. We found little high certainty evidence for most recommendations and few recommendations were made for maternal mental health and postpartum metabolic screening. Evidence gaps pertained to postpartum glucose screening, including frequency, tests, and ways to improve uptake, evaluation of effective uptake of lifestyle interventions, and ongoing long-term follow up care.
Most of the postnatal care recommendations in GDM guidelines are not based on high certainty evidence. Further efforts are needed to improve the global evidence base for postnatal care after GDM to improve long-term maternal health.
This review was registered in PROSEPRO (CRD42023454900).
妊娠期糖尿病（GDM）是妊娠期间最常见的代谢紊乱，之后与 2 型糖尿病和其他代谢紊乱的风险增加相关。一致和基于证据的产后护理是改善产妇长期健康的关键。因此，我们旨在审查和比较 GDM 后产后护理的国家和国际临床实践指南（CPG）的建议，并确定建议中需要进一步研究的任何证据差距。
我们搜索了五个数据库和四十个专业组织网站，以寻找提供 GDM 后产后护理建议的 CPG。符合条件的 CPG 必须具有英文全文、由专业机构认可、制定、编写或授权，并且在 2013 年至 2023 年之间发布。两名审查员独立筛选文章、提取建议，并使用评估指南研究与评价（AGREE）II 工具评估纳入的 CPG。
共有来自 22 个国家的 26 项 CPG 被纳入。12 项 CPG（46%）被评估为低质量，评分最低的领域是开发的严谨性和编辑独立性。我们发现大多数建议的证据确定性都较低，很少有建议涉及产妇心理健康和产后代谢筛查。证据差距涉及产后葡萄糖筛查，包括频率、测试以及提高接受度的方法、评估生活方式干预的有效接受度以及持续的长期随访护理。
大多数 GDM 指南中的产后护理建议都不是基于高确定性证据。需要进一步努力改善 GDM 后产后护理的全球证据基础，以改善产妇的长期健康。
该综述在 PROSEPRO（CRD42023454900）中进行了注册。
