Lejeune V, Milliez J
Service de Gynécologie-Obstétrique, Hôpital Saint-Antoine, Paris.
J Gynecol Obstet Biol Reprod (Paris). 1997;26(8):760-9.
Despite many international conferences, there is no consensus on gestational diabetes mellitus and many groups only screen those women who present risk factors or who present during pregnancy complications attributable to this condition. Nevertheless, complications secondary to gestational diabetes are equally frequent whether the mother presents risk factor or not, and these risk factors are only present in 30 to 45% of gestational diabetes. Therefore, all pregnant women should be screened ... or none at all. The type of screening test to be used is just as controversial. The test proposed by the WHO alone allows screening and diagnosing simultaneously, but the cut-off value at 7.8 millimoles for post-charge glycemia seems to be too low for a pregnant woman, at the end of the second trimester. The real question of whether screening for and treating gestational diabetes will actually decrease perinatal morbidity and long-term complications for the mother and the infant cannot be answered as of yet. A large prospective study would be needed, including a control group that would not be treated despite pathological glucose levels, which is ethically inconceivable.
尽管召开了许多国际会议，但对于妊娠期糖尿病仍未达成共识，许多组织只对那些存在风险因素或在孕期出现可归因于该病症并发症的女性进行筛查。然而，无论母亲是否存在风险因素，妊娠期糖尿病继发的并发症同样常见，而这些风险因素仅存在于30%至45%的妊娠期糖尿病患者中。因此，所有孕妇都应该接受筛查……或者都不筛查。所使用的筛查测试类型同样存在争议。仅世界卫生组织提议的测试能够同时进行筛查和诊断，但孕中期末对于孕妇而言，餐后血糖7.8毫摩尔的临界值似乎过低。目前尚无法回答筛查和治疗妊娠期糖尿病是否真的会降低围产期发病率以及母婴的长期并发症这一问题。这需要进行一项大型前瞻性研究，包括一个即便血糖水平异常也不接受治疗的对照组，但从伦理角度来看这是不可想象的。
