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Early testing and treatment of gestational diabetes mellitus in obese women: A systematic review of the literature.

机译：肥胖妇女妊娠糖尿病的早期检测和治疗：文献的系统评价。

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摘要

Various studies have implicated gestational diabetes mellitus (GDM) as an important environmental risk factor behind most fetal malformations, and probably, deaths. It has been reported that the incidence rate of congenital malformations in offspring of pregnant diabetic women is about three to four times more than those of infants born to non-diabetic mothers. Also, research indicates that about 7 to 10% of all pregnancies are complicated by GDM, resulting in more than 200,000 cases annually in the United States. Furthermore, a plethora of scientific investigations suggest that nearly 5 to 8% of fetuses or newborn offspring of women who have been diagnosed as having gestational diabetes have a major congenital anomaly. World Health Organization (WHO) reports indicate that prevalence of GDM in the United States is expected to rise in the coming decade due to the swelling rates of overweight and obesity in recent times; this poses a major public health problem to the United States, because pregnancy outcomes of GDM-associated births are usually not good. For instance, fetal growth can be restricted in women with GDM or those who have a fasting blood glucose level of 105 mg/dl or greater. GDM is associated with increased birth injuries and health risks for the fetus such as macrosomia, shoulder dystocia, hyperbilirubinemia and hypoglycemia, respiratory distress syndrome, and childhood obesity. Maternal risks of GDM comprise pre-eclampsia or an increased risk of developing type 2 diabetes later in life. The American College of Obstetrics and Gynecology (ACOG) suggest that all women should be screened for GDM at 24 to 28 weeks gestation but does not take consider that obese women (who might also have other risk factors) stand a higher risk of getting tested too late during pregnancy.;This study reviewed the literature for early testing and treatment of GDM (< 24 weeks gestation) in overweight or obese women to find out whether it can have significant improvement in maternal and perinatal outcomes, from the year 1980 to the present. Databases searched in this systematic review were: Ovid Medline (R) and PubMed (National Library of Medicine). Out of a total of 130 articles initially identified, only 1 was rated by two independent raters as being of high quality and subsequently selected for final abstraction, synthesis and evidence weighting. Results from this study suggest that, in overweight or obese women, early testing and treatment (< 24 weeks gestation) can lead to timely intervention and significant improvement in child and maternal health outcomes by preventing negative obstetric and neonatal outcomes. It is clear, therefore, from posited evidence in the literature that testing and treating GDM before the recommended 24 to 28 weeks in obese pregnant women play a significant role in reducing fetal or maternal complications. As such, to reduce perinatal complications and improve birth outcomes in overweight or obese women, the recommended gestation period for GDM testing and treatment in high risk populations need to be thoroughly addressed.
机译：各种研究都将妊娠糖尿病（GDM）视为大多数胎儿畸形甚至可能导致死亡的重要环境风险因素。据报道，糖尿病孕妇的后代先天畸形的发生率是非糖尿病母亲所生婴儿的三至四倍。此外，研究表明，所有妊娠中约有7％至10％的人患有GDM，在美国每年导致200,000多例。此外，大量科学研究表明，已被诊断患有妊娠糖尿病的妇女中，近5％至8％的胎儿或新生后代有严重的先天性异常。世界卫生组织（WHO）的报告显示，由于近来超重和肥胖率的上升，预计在未来十年美国GDM的发病率将上升。这给美国带来了主要的公共卫生问题，因为与GDM相关的分娩的妊娠结局通常不好。例如，患有GDM的女性或空腹血糖水平为105 mg / dl或更高的女性可能会限制胎儿的生长。 GDM与胎儿的出生受伤增加和健康风险相关，例如巨眼症，肩难产，高胆红素血症和低血糖症，呼吸窘迫综合征和儿童肥胖。 GDM的母亲风险包括先兆子痫或在生命后期发展为2型糖尿病的风险增加。美国妇产科学院（ACOG）建议，应在妊娠24至28周时对所有妇女进行GDM筛查，但不要认为肥胖妇女（可能还有其他危险因素）也有较高的接受检查的风险这项研究回顾了有关超重或肥胖妇女GDM（小于24周妊娠）的早期测试和治疗的文献，以了解从1980年至今，GDM是否可以显着改善母体和围产期结局。 。在本系统评价中搜索的数据库为：Ovid Medline（R）和PubMed（国家医学图书馆）。在最初确定的130篇文章中，只有2名独立评估者将其中1篇评为高品质，随后选择其进行最终的抽象，综合和证据加权。这项研究的结果表明，在超重或肥胖的妇女中，早期的测试和治疗（小于24周妊娠）可通过预防不良的产科和新生儿结局，导致及时干预并显着改善儿童和产妇的健康结局。因此，从文献中的明确证据可以明显看出，肥胖孕妇在建议的24至28周之前进行GDM的测试和治疗在减少胎儿或产妇并发症方面起着重要作用。因此，为减少超重或肥胖妇女的围产期并发症并改善分娩结局，需要对高危人群进行GDM检测和治疗的建议妊娠期进行彻底研究。

著录项

  • 作者

    Darko, Samuel.;

  • 作者单位

    The University of Texas School of Public Health.;

  • 授予单位 The University of Texas School of Public Health.;
  • 学科 Public health.;Obstetrics.;Nutrition.;Medicine.
  • 学位 M.P.H.
  • 年度 2013
  • 页码 46 p.
  • 总页数 46
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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