Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis.
Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis.
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DOI：
10.1136/bmj.c1395
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发表时间：
2010-04-01
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影响因子：
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通讯作者：
Siebenhofer A
中科院分区：
文献类型：
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作者：
Horvath K;Koch K;Jeitler K;Matyas E;Bender R;Bastian H;Lange S;Siebenhofer A
目的总结妊娠期糖尿病治疗的利弊。设计随机对照试验的系统回顾和荟萃分析。数据来源Embase、Medline、AMED、BIOSIS、CCMed、CDMS、CDSR、CENTRAL、CINAHL、DARE、HTA、NHS EED、Heclinet、SciSearch、多家出版商数据库和截至2009年10月的相关二级文献参考列表。审查方法纳入的研究是妊娠糖尿病特定治疗与常规护理相比或“强化”与“不太强化”特定治疗相比的随机对照试验。结果5项随机对照试验符合特异性治疗与常规治疗的纳入标准。所有研究均采用两步法，即50 g葡萄糖激发试验或筛查风险因素，或两者兼而有之，随后进行75 g或100 g口服葡萄糖耐量试验。荟萃分析未显示大多数被判定为具有直接临床重要性的单一终点的显著差异。在专门治疗妊娠期糖尿病的妇女中，肩难产明显不常见（比值比0.40，95%置信区间0.21至0.75），一项随机对照试验报告先兆子痫显著减少（2.5 v5.5%，P=0.02）。对于大于胎龄儿的替代终点，比值比为0.48（0.38至0.62）。在13项不同强度特异性治疗的随机对照试验中，荟萃分析显示，强化治疗的女性肩难产率显著降低（0.31，0.14至0.70）。结论妊娠期糖尿病的治疗，包括降低血糖浓度单独或与特殊产科护理，似乎降低了一些围产期并发症的风险。关于治疗的决定应考虑到获益的证据来自于采用两步策略（葡萄糖激发试验/风险因素筛查和口服葡萄糖耐量试验）选择的女性试验。
Objective To summarise the benefits and harms of treatments for women with gestational diabetes mellitus. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Embase, Medline, AMED, BIOSIS, CCMed, CDMS, CDSR, CENTRAL, CINAHL, DARE, HTA, NHS EED, Heclinet, SciSearch, several publishers’ databases, and reference lists of relevant secondary literature up to October 2009. Review methods Included studies were randomised controlled trials of specific treatment for gestational diabetes compared with usual care or “intensified” compared with “less intensified” specific treatment. Results Five randomised controlled trials matched the inclusion criteria for specific versus usual treatment. All studies used a two step approach with a 50 g glucose challenge test or screening for risk factors, or both, and a subsequent 75 g or 100 g oral glucose tolerance test. Meta-analyses did not show significant differences for most single end points judged to be of direct clinical importance. In women specifically treated for gestational diabetes, shoulder dystocia was significantly less common (odds ratio 0.40, 95% confidence interval 0.21 to 0.75), and one randomised controlled trial reported a significant reduction of pre-eclampsia (2.5 v 5.5%, P=0.02). For the surrogate end point of large for gestational age infants, the odds ratio was 0.48 (0.38 to 0.62). In the 13 randomised controlled trials of different intensities of specific treatments, meta-analysis showed a significant reduction of shoulder dystocia in women with more intensive treatment (0.31, 0.14 to 0.70). Conclusions Treatment for gestational diabetes, consisting of treatment to lower blood glucose concentration alone or with special obstetric care, seems to lower the risk for some perinatal complications. Decisions regarding treatment should take into account that the evidence of benefit is derived from trials for which women were selected with a two step strategy (glucose challenge test/screening for risk factors and oral glucose tolerance test).