Gestational diabetes mellitus
Gestational diabetes mellitus
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DOI：
10.1038/s41572-019-0098-8
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发表时间：
2019-07-11
影响因子：
81.5
通讯作者：
Damm, Peter
中科院分区：
文献类型：
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作者：
McIntyre, H. David;Catalano, Patrick;Damm, Peter
妊娠期间发生并在出生后消退的高血糖症已被认识超过50年，但对于值得诊断为“妊娠期糖尿病”（GDM）并因此在妊娠期间治疗的阈值高血糖水平缺乏统一的全球共识。妊娠期糖尿病是目前最常见的妊娠并发症，未确诊的高血糖症甚至明显的糖尿病在年轻女性中的患病率正在增加。母亲超重和肥胖、晚育年龄、既往GDM史、2型糖尿病家族史和种族是GDM的主要危险因素。诊断通常使用口服葡萄糖耐量试验（OGTT）进行，尽管在世界某些地区使用非空腹葡萄糖激发试验（GCT）来筛选需要完整OGTT的女性。饮食调整和增加体力活动是GDM的主要治疗方法，但当血糖未达到正常水平时，则使用药物治疗，通常是胰岛素。口服降糖药，主要是二甲双胍和格列本脲（格列本脲），也在一些国家使用。治疗可改善即刻妊娠结局，减少胎儿过度生长、肥胖和妊娠相关高血压疾病。GDM增加了母亲和婴儿的长期并发症的风险，包括肥胖、糖代谢受损和心血管疾病。在长期随访期间对母婴进行最佳管理仍然具有挑战性，在世界大多数地区，预防战略的实施非常有限。
Hyperglycaemia that develops during pregnancy and resolves after birth has been recognized for over 50 years, but uniform worldwide consensus is lacking about threshold hyperglycaemic levels that merit a diagnosis of 'gestational diabetes mellitus' (GDM) and thus treatment during pregnancy. GDM is currently the most common medical complication of pregnancy, and prevalence of undiagnosed hyperglycaemia and even overt diabetes in young women is increasing. Maternal overweight and obesity, later age at childbearing, previous history of GDM, family history of type 2 diabetes mellitus and ethnicity are major GDM risk factors. Diagnosis is usually performed using an oral glucose tolerance test (OGTT), although a non-fasting, glucose challenge test (GCT) is used in some parts of the world to screen women for those requiring a full OGTT. Dietary modification and increased physical activity are the primary treatments for GDM, but pharmacotherapy, usually insulin, is used when normoglycaemia is not achieved. Oral hypoglycaemic agents, principally metformin and glibenclamide (glyburide), are also used in some countries. Treatment improves immediate pregnancy outcomes, reducing excess fetal growth and adiposity and pregnancy-related hypertensive disorders. GDM increases the risk of long-term complications, including obesity, impaired glucose metabolism and card iovascular disease, in both the mother and infant. Optimal management of mother and infant during long-term follow-up remains challenging, with very limited implementation of preventive strategies in most parts of the world.