Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline
Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: A World Health Organization Guideline
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DOI：
10.1016/j.diabres.2013.10.012
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发表时间：
2014-03-01
影响因子：
5.1
通讯作者：
Samad, Noorjahan
中科院分区：
文献类型：
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作者：
Agarwal, Mukesh M.;Boulvain, Michel;Samad, Noorjahan
全球糖尿病的高患病率及其在孕龄妇女中的日益增加的频率产生了关于糖尿病与妊娠结局之间关系的新研究数据。世界卫生组织（世卫组织）1999年建议的妊娠期高脂血症诊断标准没有证据，需要根据以前没有的数据进行更新。更新遵循世卫组织的准则制定程序。对关键问题进行了系统评价，并采用建议评估、发展和评价分级（GRADE）方法评估证据质量，并确定妊娠期糖尿病诊断临界值的建议强度。如果缺乏证据（妊娠期糖尿病诊断）或GRADE被认为不合适（分类），则建议基于共识。队列研究的系统性综述显示，即使排除了需要治疗的更严重的高血糖症病例，妊娠期间检测到高血糖症的女性发生不良妊娠结局的风险也更大，特别是新生儿巨大儿和先兆子痫。妊娠期糖尿病（GDM）的治疗可有效减少巨大儿、大于胎龄儿、肩难产和妊娠期先兆子痫/高血压疾病。这些结果的风险降低通常很大，需要治疗的数量很低，证据的质量足以证明GDM的治疗是合理的。
The high prevalence of diabetes globally and its increasing frequency in women of gestational age have generated new research data on the relationship between glycaemia and pregnancy outcomes. The diagnostic criteria for hyperglycaemia in pregnancy recommended by the World Health Organization (WHO) in 1999 were not evidence-based and needed to be updated in the light of previously unavailable data. The update follows the WHO procedures for guidelines development. Systematic reviews were conducted for key questions, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of the evidence and to determine the strength of the recommendation on the diagnostic cut-off values for gestational diabetes. Where evidence was absent (diagnosis of diabetes in pregnancy) or GRADE was not deemed suitable (classification), recommendations were based on consensus. The systematic review of cohort studies showed that women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes, notably, macrosomia of newborn and pre-eclampsia, even after excluding the more severe cases of hyperglycaemia that required treatment. Treatment of gestational diabetes (GDM) is effective in reducing macrosomia, large for gestational age, shoulder dystocia and pre-eclampsia/hypertensive disorders in pregnancy. The risk reduction for these outcomes is in general large, the number need to treat is low, and the quality of evidence is adequate to justify treatment of GDM.