一步或两步妊娠糖尿病查和怀孕结果:更新的系统性审查和元分析
Cintia Gomes1, Itamar D Futterman1, Olivia Sher1
1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY (Drs Gomes and Futterman, Mses Sher and Gluck, and Dr Fisher).
American journal of obstetrics & gynecology MFM
|March 13, 2024
概括
妊娠糖尿病的一步查方法并没有大大增加妊娠年龄的分娩,但与两步方法相比,它导致新生儿低血糖症和新生儿重症监护室入院率更高.
科学领域:
- 产科和妇科 产科和妇科
- 新生儿医学 新生儿医学
- 临床流行病学临床流行病学
背景情况:
- 怀孕期糖尿病 (GDM) 查对母亲和新生儿健康至关重要.
- 针对GDM的1步和2步查方法具有不同的诊断标准和影响.
- 这些查方法之间的母亲和新生儿结果比较的证据对于临床实践指南至关重要.
研究的目的:
- 系统地审查和元分析与妊娠糖尿病1步和2步查方法相关的孕产妇和新生儿结局.
- 为了比较两种查方案之间的孕期婴儿,新生儿低血糖症和新生儿重症监护室入院的发生率.
主要方法:
- 进行了随机对照试验 (RCT) 的系统审查和元分析.
- 在PubMed,Scopus,Cochrane,ClinicalTrials.gov和LILACS进行了搜索,截至2022年9月.
- 风险比率 (RRs) 与95%置信区间 (CI) 计算了主要和次要结果,包括妊娠年龄大,新生儿低血糖,NICU入院和GDM诊断.
主要成果:
- 包括7个RCT,涉及54,650名参与者. 在1步和2步查组之间,对于妊娠年龄的比例没有发现重大差异 (RR,0.99;95% CI,0.93-1.05).
- 一步查方法与新生儿低血糖率 (RR,1.24;95% CI,1.14-1.34) 和新生儿重症监护病房入院率 (RR,1.13;95% CI,1.04-1.21) 显著上升.
- 孕期糖尿病的母亲诊断在1步组中也更高 (RR,1.73;95% CI,1.44-2.09).
结论:
- 虽然GDM的一步查方法不会增加孕期婴儿大小的风险,但它与新生儿不良结果有关.
- 与两步方法相比,一步方法导致新生儿低血糖症和新生儿重症监护室入院率更高.
- 临床医生在选择GDM查方案时应考虑这些发现,平衡诊断产量与潜在的新生儿风险.
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