在瑞典改变妊娠期糖尿病 (CDC4G) 诊断标准:一个阶梯集群随机试验
Maryam de Brun1, Anders Magnuson2, Scott Montgomery2,3,4
1Department of Obstetrics and Gynaecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
PLoS medicine
|July 8, 2024
概括
在瑞典切换到世界卫生组织 (WHO) 2013年妊娠糖尿病 (GDM) 标准并没有显著降低妊娠年龄大 (LGA) 婴儿的患病率. 需要进一步的研究来优化GDM查和管理,以改善母亲和婴儿的健康.
科学领域:
- 产科和妇科 产科和妇科
- 内分泌学 在内分泌学.
- 公共卫生 公共卫生
背景情况:
- 世界卫生组织 (WHO) 2013年对妊娠糖尿病 (GDM) 的诊断标准已经面临对其对怀孕结果的影响的审查.
- 支持在不同人群中降低血糖值的益处的证据仍然有限.
- 这项研究评估了瑞典从以前的瑞典语 (SWE-GDM) 过渡到世卫组织2013年GDM标准的情况.
研究的目的:
- 评估采用世卫组织2013年GDM标准是否改善了瑞典的怀孕结果.
- 为了比较妊娠年龄大 (LGA) 婴儿在标准切换前后的患病率.
- 分析GDM定义不一致的子组中的结果.
主要方法:
- 一个阶梯集群随机试验,涉及2018年1月至12月在瑞典各地的17个配送单位.
- 纳入标准不包括先前存在的糖尿病,胃绕道和多胎妊娠.
- 主要结局:LGA (出生体重>90百分位). 分析使用了多层混合回归模型.
主要成果:
- 干预后的GDM患病率从2.6%增加到6.6%.
- 在总人口中LGA患病率没有显著变化 (调整后风险比为0.97;95% CI为0.91至1.02).
- 在一个不一致的小组中,LGA患病率下降 (调整后风险比为0.87;95% CI为0.75至1.01),但没有显著下降.
结论:
- 实施基于风险的查的WHO-2013标准并没有显著降低瑞典LGA患病率.
- 需要进一步的研究来评估各种人群中的GDM查和管理策略.
- 优化指南对于改善短期和长期母亲和婴儿健康至关重要.
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