双胞胎怀孕中的孕期糖尿病 - - 是需要治疗的病理还是良性生理适应?
Nir Melamed1, Tomer Avnon2, Jon Barrett3
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Ontario, Canada.
双胞胎怀孕中的孕期糖尿病可能是生理性的,而不是病理性的. 目前对单生儿的诊断标准可能会导致双胞胎的过度诊断和过度治疗,需要针对双胞胎的具体指南.
科学领域:
- 产科和妇科 产科和妇科
- 内分泌学 在内分泌学.
- 周围生理学 周围生理学
背景情况:
- 孕期糖尿病 (GDM) 查和单子妊娠的治疗可以降低孕产妇和新生儿的死亡率.
- 目前双胞胎怀孕的GDM诊断和管理使用单个标准,尽管有独特的生理差异.
- 双胞胎怀孕表现出增加的胰岛素耐药性,通常被诊断为饮食治疗的GDM,质疑其病理性质.
研究的目的:
- 审查目前关于双胞胎怀孕中GDM的证据.
- 评估双胞胎单个诊断标准的适当性.
- 探索对双胞胎特异性GDM查和诊断标准的需求.
主要方法:
- 对双胞胎怀孕中GDM当前文献的系统综述.
- 对流行病学,病理生理学和临床数据的分析.
- 审查现有和拟议的双胞胎特异性查和诊断标准.
主要成果:
- 双胞胎怀孕的饮食治疗GDM发病率较高,但与单子怀孕相比,不良后果较少.
- 双胞胎饮食治疗的GDM可能会降低子宫内生长限制的风险.
- 证据不支持双胞胎GDM治疗改善结果;严格控制可能会增加风险.
结论:
- 双胞胎怀孕中胰岛素抵抗的增加可能是一种生理适应,以支持两个胎儿.
- 目前的单一标准可能导致双胞胎GDM过度诊断和过度治疗.
- 制定双胞胎特异性查和诊断标准对于避免不必要的干预和改善结果至关重要.
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