Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria.
Gestational diabetes and pregnancy outcomes--a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria.
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DOI：
10.1186/1471-2393-12-23
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发表时间：
2012-03-31
影响因子：
3.1
通讯作者：
Schmidt MI
中科院分区：
文献类型：
--
作者：
Wendland EM;Torloni MR;Falavigna M;Trujillo J;Dode MA;Campos MA;Duncan BB;Schmidt MI
基于2小时75克OGTT的两个标准被用于诊断妊娠期糖尿病(GDM)，世界卫生组织(WHO)多年来推荐的标准，以及国际妊娠期糖尿病协会(IADPSG)最近推荐的标准，后者是在HAPO研究和妊娠结局的基础上产生的。我们的目标是系统地审查妊娠期糖尿病(根据这些标准)和不良结果之间的联系的证据。计算机检索MEDLINE、EMBASE、Lilacs、Cochrane图书馆、CINHAL、WHO-Afro图书馆、IMSEAR、EMCAT、IMEMR和WPRIM等相关文献。我们纳入了允许评估WHO和/或IADPSG标准诊断的妊娠期糖尿病的队列研究，以对抗未经治疗的妇女的不良孕产妇和围产儿结局。只纳入了普遍应用75g OGTT的研究。获得每项研究的相对危险度(RR)及其95%可信区间(CI)。我们使用随机效应模型结合了研究结果。各研究之间的不一致由不一致指数(I2)和50%来定义。数据来自8项研究，总计44,829名女性。两种诊断标准都观察到较大的不良结果风险。在使用世界卫生组织的标准时，与巨大儿(RR=1.81；95%CI1.47-2.22；p<；0.001)；胎龄较大(RR=1.53；95%CI1.39-1.69；p<；0.001)；围产儿死亡率(RR=1.55；95%CI0.88-2.73；p=0.13)；先兆子痫(RR=1.69；95%CI1.31-2.18；p<；0.001)；剖宫产(RR=1.37；95%可信区间1.24~1.51；P<；0.001)。IADPSG标准可获得的数据较少，而且各研究之间的相关性不一致(I2≥73%)。胎龄较大者RRS及其95%Cis分别为1.73(1.28~2.35；p=0.001)、子痫前期1.71(1.38~2.13；p<；0.001)、剖宫产1.23(1.01~1.51；p=0.04)。排除HAPO或EBDG研究对这些相关性的影响最小，但IADPSG标准的RRS在排除HAPO后降低。世卫组织和IADPSG的妊娠期糖尿病标准确定了不良妊娠结局风险略有增加的妇女。在这两个标准中，相关性的大小相似。然而，那些符合IADPSG标准的人看到了高度不一致的情况。在HAPO以外的环境中对后者进行全面评估需要进行额外的研究。
Two criteria based on a 2 h 75 g OGTT are being used for the diagnosis of gestational diabetes (GDM), those recommended over the years by the World Health Organization (WHO), and those recently recommended by the International Association for Diabetes in Pregnancy Study Group (IADPSG), the latter generated in the HAPO study and based on pregnancy outcomes. Our aim is to systematically review the evidence for the associations between GDM (according to these criteria) and adverse outcomes. We searched relevant studies in MEDLINE, EMBASE, LILACS, the Cochrane Library, CINHAL, WHO-Afro library, IMSEAR, EMCAT, IMEMR and WPRIM. We included cohort studies permitting the evaluation of GDM diagnosed by WHO and or IADPSG criteria against adverse maternal and perinatal outcomes in untreated women. Only studies with universal application of a 75 g OGTT were included. Relative risks (RRs) and their 95% confidence intervals (CI) were obtained for each study. We combined study results using a random-effects model. Inconsistency across studies was defined by an inconsistency index (I2) > 50%. Data were extracted from eight studies, totaling 44,829 women. Greater risk of adverse outcomes was observed for both diagnostic criteria. When using the WHO criteria, consistent associations were seen for macrosomia (RR = 1.81; 95%CI 1.47-2.22; p < 0.001); large for gestational age (RR = 1.53; 95%CI 1.39-1.69; p < 0.001); perinatal mortality (RR = 1.55; 95% CI 0.88-2.73; p = 0.13); preeclampsia (RR = 1.69; 95%CI 1.31-2.18; p < 0.001); and cesarean delivery (RR = 1.37;95%CI 1.24-1.51; p < 0.001). Less data were available for the IADPSG criteria, and associations were inconsistent across studies (I2 ≥ 73%). Magnitudes of RRs and their 95%CIs were 1.73 (1.28-2.35; p = 0.001) for large for gestational age; 1.71 (1.38-2.13; p < 0.001) for preeclampsia; and 1.23 (1.01-1.51; p = 0.04) for cesarean delivery. Excluding either the HAPO or the EBDG studies minimally altered these associations, but the RRs seen for the IADPSG criteria were reduced after excluding HAPO. The WHO and the IADPSG criteria for GDM identified women at a small increased risk for adverse pregnancy outcomes. Associations were of similar magnitude for both criteria. However, high inconsistency was seen for those with the IADPSG criteria. Full evaluation of the latter in settings other than HAPO requires additional studies.
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影响因子：
16.2
作者：
Sacks DA;Hadden DR;Maresh M;Deerochanawong C;Dyer AR;Metzger BE;Lowe LP;Coustan DR;Hod M;Oats JJ;Persson B;Trimble ER;HAPO Study Cooperative Research Group
通讯作者：
HAPO Study Cooperative Research Group
影响因子：
16.2
作者：
Agarwal MM;Dhatt GS;Shah SM
通讯作者：
Shah SM
影响因子：
5
作者：
Pepe, MS;Janes, H;Newcomb, P
通讯作者：
Newcomb, P
DOI：
10.1111/j.1479-828x.1994.tb01033.x
发表时间：
1994-02-01
影响因子：
1.7
作者：
KHAN, KS;SYED, AH;RIZVI, JH
通讯作者：
RIZVI, JH
影响因子：
16.2
作者：
Schmidt, MI;Duncan, BB;Yamashita, T
通讯作者：
Yamashita, T