Gestational diabetes: dilemma caused by multiple international diagnostic criteria
Gestational diabetes: dilemma caused by multiple international diagnostic criteria
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DOI：
10.1111/j.1464-5491.2005.01706.x
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发表时间：
2005-12-01
影响因子：
3.5
通讯作者：
Koster, G
中科院分区：
文献类型：
--
作者：
Agarwal, MM;Dhatt, GS;Koster, G
目的 强调六个公认的国际专家小组定义的妊娠糖尿病 (GDM) 诊断的差异。方法 两千五百五十四名孕妇接受了 75 克口服葡萄糖耐量试验，以进行常规产前 GDM 筛查。使用美国糖尿病协会、澳大利亚妊娠期糖尿病协会、加拿大糖尿病协会、欧洲糖尿病研究协会、新西兰糖尿病研究协会和世界卫生组织（WHO）的标准对她们进行分类。 结果 在任何两个标准之间，GDM 患病率（范围；7.9-24.9%）和分类不同的女性[范围； 70 (2.7%)-454 (17.8%) 女性]，具有显着性(P < 0.001)。尽管最具包容性的标准（即澳大利亚人）产生了最高的 GDM 患病率，但并未涵盖最严格的标准（即加拿大人）确定的所有女性。澳大利亚和世界卫生组织的标准与剖腹产数量的增加有关[比值比 (OR)；分别为 1.64、1.45]，而美国、加拿大和新西兰的标准则确定巨大儿（出生体重 >= 4000 g）发病率有所增加（OR；分别为 2.09、2.01、1.92）。 结论 各专业委员会的指南基于共识和专家意见，在识别 GDM 妇女的能力和预测不良妊娠结局的能力方面存在重大差异。只有源自可靠且一致的科学数据的循证标准才能消除临床实践中造成的混乱。
Aims To highlight the variation in the diagnosis of gestational diabetes (GDM) as defined by six well-accepted international expert panels.Methods Two thousand, five hundred and fifty-four pregnant women underwent a 75-g oral glucose tolerance test for routine, antenatal GDM screening. They were classified using the criteria of the American Diabetes Association, Australasian Diabetes in Pregnancy Society, the Canadian Diabetes Association, the European Association for the Study of Diabetes, the New Zealand Society for the study of Diabetes and the World Health Organization (WHO).Results Between any two criteria, both the GDM prevalence (range; 7.9-24.9%) and the women classified differently [range; 70 (2.7%)-454 (17.8%) women], was significant (P < 0.001). The most inclusive criteria, i.e. Australasian, despite generating the highest prevalence of GDM, did not pick up all the women identified by the most restrictive criteria, i.e. Canadian. The Australasian and the WHO criteria were associated with an increase in the number of Caesarean sections [odds ratio (OR); 1.64, 1.45, respectively] while the American, Canadian and New Zealand criteria identified an increase in macrosomia (birthweight >= 4000 g) incidence (OR; 2.09, 2.01, 1.92, respectively).Conclusions The guidelines of the various professional committees, being based on consensus and expert opinion, show major discrepancies in their ability to identify women with GDM and their capacity to predict adverse pregnancy outcome. Only evidence-based criteria derived from reliable and consistent scientific data will eliminate the confusion caused in clinical practice.