Postpartum diabetes screening in women with a history of gestational diabetes
Postpartum diabetes screening in women with a history of gestational diabetes
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DOI：
10.1097/01.aog.0000189081.46925.90
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发表时间：
2005-12-01
影响因子：
7.2
通讯作者：
Thadhani, R
中科院分区：
文献类型：
--
作者：
Smirnakis, KV;Chasan-Taber, L;Thadhani, R
目的：有妊娠期糖尿病(GDM)病史的女性是罹患2型糖尿病(DM)的高危人群。美国糖尿病协会建议有GDM病史的女性定期进行产后糖尿病筛查，但美国妇产科医生学会(ACOG)并不这样做。我们试图检查被诊断为GDM的妇女的产后血糖测试。方法：我们在2000-2001年间在两个大型学术医学中心之一对被诊断为GDM的妇女进行了一项观察性队列研究。Kaplan-Meier估计从分娩到第一次产后糖尿病筛查的时间，并使用Cox比例风险检验检验产后糖尿病筛查的预测因素。结果：只有37%的符合条件的妇女接受了美国糖尿病协会推荐的产后糖尿病筛查测试(空腹血糖或口服葡萄糖耐量试验[OGTT])，从分娩到第一次此类测试的中位时间为428天。相比之下，94%的妇女使用巴氏试验(Pap)进行了产后宫颈癌筛查，从分娩到巴氏试验的中位数时间为49天。即使随机血糖测试被纳入产后糖尿病筛查的广泛定义(随机或空腹血糖、糖化血红蛋白或OGTT)，也只有三分之二(67%)的女性接受了产后血糖评估。结论：在被研究的人群中，根据美国糖尿病协会发布的指南，只有37%有GDM病史的女性进行了产后糖尿病筛查。在这一高危人群中努力改进产后糖尿病筛查是有必要的。
OBJECTIVE: Women with a history of gestational diabetes mellitus (GDM) are at high risk for developing type 2 diabetes (diabetes mellitus, DM). The American Diabetes Association recommends regular postpartum diabetes screening for women with a history of GDM, but the American College of Obstetricians and Gynecologists (ACOG) is not as directive. We sought to examine postpartum glycemic testing in women diagnosed with GDM.METHODS: We conducted an observational cohort study of women diagnosed with GDM at one of two large academic medical centers between 2000 and 2001. Kaplan-Meier estimates of the time from delivery to the first postpartum DM screening tests were determined, and predictors of postpartum DM screening were examined using Cox proportional hazards testing.RESULTS: Only 37% of eligible women underwent the postpartum diabetes screening tests recommended by the American Diabetes Association (fasting glucose or oral glucose tolerance test [OGTT]), with a median time from delivery to the first such testing of 428 days. By comparison, 94% of women underwent postpartum cervical cancer screening using a Papanicolaou (Pap) test, with a median time from delivery to Pap testing of 49 days. Even when random glucose testing was included in a broad definition of postpartum DM screening (random or fasting glucose, glycosylated hemoglobin, or OGTT), only two thirds of women (67%) received a postpartum glycemic assessment.CONCLUSION: In the population studied, only 37% of women with a history of GDM were screened for postpartum DM according to guidelines published by the American Diabetes Association. Efforts to improve postpartum DM screening in this high-risk group are warranted.