Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes.
Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes.
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DOI：
10.1515/jpm-2021-0581
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发表时间：
2022-10-26
影响因子：
2.4
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中科院分区：
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在妊娠24-28周进行妊娠糖尿病（GDM）筛查可降低不良孕产妇和围产期结局的风险。虽然专家建议对高危患者（包括肥胖患者）进行早期筛查，但支持这一建议的数据有限。我们实施了一项系统性的人群干预措施，鼓励2009-2013年在两个综合卫生系统中的肥胖孕妇队列中通过口服葡萄糖耐量试验进行妊娠早期GDM筛查，并将结果与干预前（2006-2009年）相同的人群进行比较。在干预后组的GDM病例中评估了长达五年的产后葡萄糖检测结果（至2018年）。主要结局为大于胎龄出生体重（LGA）、巨大儿、围产期复合结局、妊娠期高血压/先兆子痫、剖宫产和GDM的药物治疗。40，206例患者（9，156例肥胖）接受了GDM筛查; 2，672例（6.6%）被诊断为GDM。总体而言，干预后LGA和剖宫产的多变量校正风险较低（LGA：aOR 0.89 [0.82，0.96];剖宫产：0.89 [0.85，0.93]）。这种差异在诊断为GDM的患者中更为明显（LGA：aOR 0.52 [0.39，0.70];剖宫产0.78 [0.65，0.94]）;干预后GDM的胰岛素/口服降糖治疗率也高于干预前（22% vs. 29%; p<0.0001）。其他主要结局无差异。在妊娠早期诊断为GDM的患者中，只有20%的产后检测结果在明显的糖尿病范围内，这表明在妊娠早期检测到糖尿病谱。妊娠早期肥胖孕妇GDM筛查可改善GDM相关结局
Gestational diabetes (GDM) screening at 24–28 weeks’ gestation reduces risk of adverse maternal and perinatal outcomes. While experts recommend first-trimester screening for high-risk patients, including those with obesity, data supporting this recommendation is limited. We implemented a systematic population intervention to encourage first-trimester GDM screening by oral glucose tolerance testing in a cohort of pregnant people with obesity in two integrated health systems from 2009–2013, and compared outcomes to the same population pre-intervention (2006–2009). Up to five years of postpartum glucose testing results (through 2018) were assessed among GDM cases in the post-intervention group. Primary outcomes were large-for-gestational-age birthweight (LGA); macrosomia; a perinatal composite outcome; gestational hypertension/preeclampsia; cesarean delivery; and medication treatment of GDM. 40,206 patients (9,156 with obesity) were screened for GDM; 2,672 (6.6%) were diagnosed with GDM. Overall, multivariate adjusted risk for LGA and cesarean delivery were lower following the intervention (LGA: aOR 0.89 [0.82,0.96]; cesarean delivery: 0.89 [0.85, 0.93]). This difference was more pronounced in patients diagnosed with GDM (LGA: aOR 0.52 [0.39,0.70]; cesarean delivery 0.78 [0.65, 0.94]); insulin/oral hypoglycemic treatment rates for GDM were also higher post-intervention than pre-intervention (22% vs. 29%; p<0.0001). There were no differences for the other primary outcomes. Only 20% of patients diagnosed with GDM early in pregnancy who had postpartum testing had results in the overt diabetes range, suggesting a spectrum of diabetes detected early in pregnancy. First trimester GDM screening for pregnant people with obesity may improve GDM-associated outcomes.
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5.1
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