Maternal outcome of gestational diabetes mellitus
Maternal outcome of gestational diabetes mellitus
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DOI：
10.1016/j.diabet.2010.11.006
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发表时间：
2010-12-01
影响因子：
7.2
通讯作者：
Dreyfus, M.
中科院分区：
文献类型：
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作者：
Beucher, G.;de Lesegno, B. Viaris;Dreyfus, M.
目的：评估治疗或未治疗妊娠期糖尿病 (GDM) 的孕产妇结局。方法：使用 PubMed 和 Cochrane 图书馆检索法文和英文出版物。结果：GDM 的诊断包括先兆子痫和剖腹产 (EL3) 的高危人群。风险与高血糖水平呈线性正相关（EL2）。与常规护理相比，轻度 GDM 的强化治疗可降低妊娠高血压（先兆子痫、妊娠期高血压）的风险。此外，它不会增加手术阴道分娩、剖腹产和产后出血（EL1）的风险。超重、肥胖和母亲高血糖是先兆子痫（EL2）的独立危险因素。与体重指数 (EL3) 正常的糖尿病女性相比，她们与 GDM 的相关性增加了先兆子痫和剖腹产的风险。多种危险因素（例如高龄产妇、既往慢性高血压、既往肾病、肥胖、血糖控制不佳）的关联会增加先兆子痫的风险。在这种情况下，经典的随访（血压测量、蛋白尿）应该比每月一次更频繁（专业共识）。无论是否在产前怀疑，巨大儿都会增加剖腹产的风险，但无论出生体重如何，这种增加的风险仍然存在（EL3）。 GDM 的诊断和治疗并不能降低严重会阴病变、阴道手术分娩和产后出血 (EL2) 的风险。诊断 GDM (EL3) 后可能会出现一些心理症状，例如焦虑和自我认知改变。 GDM 的治疗似乎可以降低产后抑郁症状（EL2）的风险。结论：大多数关于 GDM 的信息都涵盖了先兆子痫和剖腹产的风险； GDM 的重症监护可降低这些风险。应根据危险因素调整妊娠护理。 (C) 2010 Elsevier Masson SAS。版权所有。
Objective: To estimate maternal outcome of treated or untreated gestational diabetes mellitus (GDM).Methods: French and English publications were searched using PubMed and the Cochrane library.Results: The diagnosis of GDM includes a high risk population for preeclampsia and Caesarean sections (EL3). The risks are positively correlated with the level of hyperglycaemia in a linear way (EL2). Intensive treatment of mild GDM compared with routine care reduces the risk of pregnancy-induced hypertension (preeclampsia, gestational hypertension). Moreover, it does not increase the risk of operative vaginal delivery, Caesarean section and postpartum haemorrhage (EL1). Being overweight, obesity and maternal hyperglycaemia are independent risk factors for preeclampsia (EL2). Their association with GDM increases the risk of preeclampsia and Caesarean section compared to diabetic women with a normal body mass index (EL3). The association of several risk factors (such as advanced maternal age, pre-existing chronic hypertension, pre-existing nephropathy, obesity, suboptimal glycaemic control) increases the risk of preeclampsia. In that case, the classic follow-up (blood pressure measurement, proteinuria) should be more frequent than monthly (professional consensus). The risk of Caesarean section is increased by macrosomia, whether suspected prenatally or not, but this increased risk remains whatever the birth weight (EL3). Diagnosis and treatment of GDM do not reduce the risk of severe perineal lesions, operative vaginal delivery and postpartum haemorrhage (EL2). Some psychological symptoms, such as anxiety and alteration of self-perception, can occur upon diagnosis of GDM (EL3). The treatment of GDM appears to reduce the risk of postpartum depression symptoms (EL2).Conclusion: Most of the information published on GDM covers the risks of preeclampsia and Caesarean section; intensive care of GDM reduces these risks. Pregnancy care should be adjusted to the risk factors. (C) 2010 Elsevier Masson SAS. All rights reserved.