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围产期结果根据妊娠期糖尿病的治疗目标:多中心回顾性队列研究
Stephanie L Montalto1, Melvin Marzan2, Christine Houlihan1
1Mercy Health, Heidelberg, Victoria, Australia.
概括
对于妊娠糖尿病 (GDM) 的更严格的禁食血糖目标并没有改善婴儿的结果,但增加了药物使用. 这项研究比较了GDM怀孕的结果,其中更严格的葡萄糖控制与不那么严格的葡萄糖控制.
科学领域:
- 产科和妇科 产科和妇科
- 内分泌学 在内分泌学.
- 围产儿医学 围产儿医学
背景情况:
- 妊娠期糖尿病 (GDM) 影响澳大利亚18%的怀孕,可能导致妊娠年龄大 (LGA) 婴儿和其他并发症.
- 对GDM的最佳治疗目标仍未确定,这突显了临床指南中的关键差距.
- 目前的GDM管理缺乏关于理想的空腹血糖水平 (BGL) 目标的共识.
研究的目的:
- 为了比较患有GDM的女性的围产期结局,治疗更严格和更不严格的空腹血糖水平 (BGL) 目标.
- 评估不同GDM BGL目标与妊娠年龄大 (LGA) 婴儿的发生率之间的关联.
- 评估GDM BGL目标对药物治疗需求的影响.
主要方法:
- 在12个大都会维多利亚州医院 (2020-2022) 进行了25 041例分娩的回顾性队列研究.
- 纳入标准:有GDM诊断的单生婴儿.
- "更紧" (BGL <5.0-5.2 mmol/L) 和"不太紧" (BGL <5.5-5.6 mmol/L) 禁食BGL目标群体之间的结果比较,使用多级Poisson回归与反向概率治疗权重.
主要成果:
- 在更紧密的 (10.4%) 和不那么紧密的 (9.5%) BGL目标群体 (p=0.85) 之间,LGA出生没有显著差异.
- 在更严格的BGL目标群体中增加胰岛素治疗 (53%对35%,p<0.001).
- 两组之间没有观察到二次围产期结果的显著差异.
结论:
- 在GDM怀孕中,更严格的禁食BGL目标与改善的围产期结果无关.
- 实施更严格的BGL目标导致需要药物治疗的可能性更高,例如胰岛素.
- 这些发现表明,目前对GDM的更严格的禁食BGL目标可能不会在婴儿大小方面提供临床益处,并增加医疗干预率.
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