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妊娠糖尿病的流行病学和管理
Arianne Sweeting1, Wesley Hannah2, Helena Backman3
1Department of Endocrinology, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia.
Lancet (London, England)
|June 23, 2024
概括
孕期糖尿病影响14%的孕妇, 需要及时诊断和治疗. 早期检测和干预,特别是早期妊娠糖尿病,可以改善妊娠结果并减少并发症.
科学领域:
- 产科和妇科
- 内分泌学
- 公共卫生
背景情况:
- 孕期糖尿病 (GDM) 影响全球约14%的孕妇.
- 与肥胖和2型糖尿病相关的患病率上升 (糖尿病流行).
- 与显著的直接成本和不良妊娠结果相关,包括高血压疾病和新生儿并发症.
研究的目的:
- 以诊断时间和亚型来突出GDM的异质性.
- 强调需要采用精准医疗方法来管理GDM.
- 倡导基于证据的预防,诊断和治疗策略.
主要方法:
- 现有文献和临床试验数据的审查,包括高血糖和不良妊娠结果研究和预约妊娠糖尿病治疗 (TOBOGM) 试验.
- 基于妊娠时间的诊断标准和治疗效益的分析.
- 考虑糖尿病流行病的影响和技术进步.
主要成果:
- 在怀孕20周前诊断的GDM (早期GDM) 与晚些时候诊断的GDM (从24周到28周) 相比,与更差的妊娠结果有关.
- 有证据表明早期诊断和治疗GDM有好处,特别是在有风险因素的女性中.
- 目前的世卫组织诊断指南 (2013) 主要关注怀孕后期的查.
结论:
- 由于GDM的异质性,一个"适合所有人"的方法是不够的.
- 一个终身精准医学策略对于有效的GDM预防,诊断和治疗至关重要.
- 需要进一步的研究和更新的指导方针来解决早期的GDM问题,并改善孕产妇与胎儿之间的关系.
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