妊娠期糖尿病高危人群生活方式指导的最佳证据总结

目的 系统检索、评价并总结国内外有关妊娠期糖尿病（gestational diabetes mellitus,GDM）高危人群生活方式指导预防GDM的最佳证据,为临床医护人员指导GDM高危人群预防GDM提供循证证据。方法 系统检索BMJ Best Practice,Cochrane Library,医脉通指南网、英国国家卫生与临床优化研究所、国际糖尿病与妊娠研究组、PubMed,Web of Science,Science Direct,澳大利亚实践指南（Australian clinical practice guidelines,ACPG）、中国知网、万方、CBM数据库和相关协会网站中GDM高危人群生活方式指导的最佳证据。检索时限为2015年6月至2022年6月。由2名研究者分别对纳入的文献进行质量评价。结果 共纳入文献22篇,其中临床指南6篇,专家共识2篇,系统评价10篇,随机对照试验4篇。共总结了早期筛查、饮食指导、运动指导及体重管理指导四个方面17条最佳证据。结论 该证据总结可为临床医护人员对GDM高危人群进行生活方式指导及制定生活方式干预方案提供循证参考依据。     

妊娠期糖尿病患者产后糖代谢异常预防性干预的范围综述

目的 对妊娠期糖尿病（GDM）患者产后糖代谢异常预防性干预措施进行范围审查，为深入开展后续研究提供参考。方法 以Arksey等制订的范围综述为方法学框架，检索PubMed、Medline、Web of Science、Cochrane Library、JBI、Embase、中国知网、万方、维普和中国生物医学数据库中GDM患者产后糖代谢异常预防性干预相关研究。检索时限为建库至2021年11月1日，两名研究员对纳入文献进行汇总和分析。结果 共纳入90篇文献，GDM患者产后糖代谢异常预防性干预措施主要包括血糖筛查、饮食疗法、运动干预、母乳喂养和生活方式综合干预，影响GDM患者产后糖代谢异常风险认知和管理的障碍因素包括个人因素和系统因素。结论 预防性干预对GDM患者产后糖代谢有改善作用，建议协同网络技术和患者家属参与对GDM患者进行个性化血糖筛查提醒。未来研究需结合基于理论基础的个性化干预措施，构建基于需求的科学合理、规范化产后糖代谢异常综合干预体系。     

妊娠期糖尿病孕产妇母乳喂养指导与管理的最佳证据总结

目的总结妊娠期糖尿病孕产妇母乳喂养指导与管理的相关证据。方法计算机检索UpToDate、BMJ Best Practice、CINAHL、PubMed、Cochrane Library、Embase、万方数据库、中国知网等数据库及专业网站中关于妊娠期糖尿病孕产妇母乳喂养指导与管理的证据, 包括临床决策、指南、证据总结、系统评价、专家共识及随机对照试验, 检索时限为建库至2023年4月1日。由2名研究者独立进行文献质量评价、证据提取及整合。结果共纳入23篇文献, 包括临床决策4篇、指南4篇、证据总结4篇、系统评价6篇、专家共识1篇、随机对照试验4篇, 从支持教育、知识技能、安全问题、喂养问题、饮食护理和血糖监测6个方面总结出21条最佳证据。结论本研究总结了妊娠期糖尿病孕产妇母乳喂养指导与管理的最佳证据, 建议医护人员结合临床情境及患者意愿应用证据。     

妊娠期糖尿病临床护理实践指南的更新

目的对课题组2018年构建的妊娠期糖尿病临床护理实践指南进行更新和补充。方法系统检索国内外专业网站及数据库关于妊娠期糖尿病临床护理的最新证据;由2名研究员对文献质量进行独立评价,对纳入的文献进行资料提取和证据汇总,并采用Delphi法,通过专家咨询达成推荐意见及推荐强度。结果共纳入7篇指南和49篇系统评价;结合专业人员的判断,总结出14条妊娠期糖尿病患者筛查及管理的相关证据,包括疾病筛查和诊断、饮食干预、运动干预、血糖监测和产后复查等方面。经过专家共识,确定7条强推荐,7条弱推荐。结论本研究总结了目前关于妊娠期糖尿病患者筛查及管理的最新最佳证据,对原有的妊娠期糖尿病临床护理实践指南进行了更新,可为临床护理人员提供基于证据的决策建议和依据,促进妊娠期糖尿病的规范化管理。     

母乳喂养产妇乳头疼痛或损伤预防及管理的最佳证据总结

目的检索、评价并总结母乳喂养产妇乳头疼痛或损伤预防及管理的最佳证据, 为母乳喂养临床实践提供循证依据。方法根据"6S"证据金字塔模型系统性检索母乳喂养产妇乳头疼痛或损伤预防及管理相关的临床决策、指南、专家共识、证据总结及系统评价, 检索时限为建库至2023年3月10日。由研究小组成员根据相应的文献质量评价标准对纳入文献独立进行质量评价, 并结合专业判断对最终所纳入文献进行证据提取及汇总。结果共纳入15篇文献, 包括临床决策2篇, 指南7篇, 系统评价6篇。最终总结了19条最佳证据, 包括乳头疼痛或损伤的评估、乳头疼痛或损伤的预防、乳头疼痛或损伤的管理、健康教育4个主题。结论产科护士及助产士应结合具体的临床情景为母乳喂养产妇提供标准化护理, 降低母乳喂养产妇乳头疼痛或损伤的发生率, 促进产妇坚持母乳喂养。     

妊娠期糖尿病患者产后血糖筛查影响因素和促进措施的研究进展

妊娠期糖尿病(GDM)患者产后进行血糖筛查可以为预防产后糖尿病提供早期诊断，有助于降低产后糖尿病的发生率和改善GDM患者产后的生活质量。本文对国内外GDM患者产后血糖筛查影响因素以及产后血糖筛查的促进措施进行综述，旨在为GDM患者产后血糖筛查管理提供依据，达到预防GDM产后演变为糖尿病的目的。     

产后管理干预在妊娠期糖尿病妇女中的应用

[目的]探讨产后管理干预对妊娠期糖尿病(GDM)产妇的影响,为降低GDM妇女远期患糖尿病的风险研究提供依据。[方法]选取GDM产后妇女作为研究对象,分为干预组(150例)和对照组(100例),对干预组妇女进行糖尿病教育、膳食指导、制定运动方案、电话随访个性指导等产后管理干预;对照组只做常规管理,两组妇女均在产后3d、42d及12周、半年、1年共5个时段监测体质指数(BMI)、空腹及餐后血糖、糖化血红蛋白、脂蛋白、75g口服葡萄糖耐量试验(OGTT)筛查、疾病认知程度等指标。[结果]本组GDM发病率为9.9%;干预组产后12周至产后1年BMI、空腹血糖值、餐后血糖值低于对照组;两组GDM妇女干预前后对疾病认知情况比较差异有统计学意义(P0.05)。[结论]对患GDM的妇女进行产后管理干预能提高妇女对GDM的疾病认知,能够有效地降低GDM妇女的BMI、控制血糖,改善糖代谢。     

终末期糖尿病肾病血液透析患者血糖管理最佳证据总结

目的检索、评价并整合终末期糖尿病肾病血液透析患者的血糖管理最佳证据, 为临床循证实践提供依据。方法计算机系统检索包括BMJ最佳临床实践、Cochrane Library、OVID、Scopus、UpToDate、中国知网、万方、医脉通等数据库、指南网以及专业协会网站中关于终末期糖尿病肾病血液透析患者血糖管理的相关证据, 检索时限为建库至2023年5月10日。结果共纳入文献14篇, 其中指南5篇、系统评价6篇、临床决策1篇、随机对照试验1篇、专家共识1篇, 总结出关于终末期糖尿病肾病血液透析患者血糖全程管理最佳证据25条, 涵盖透析前评估、透析前血糖管理、透析过程中血糖管理、透析间歇期血糖管理、饮食与营养管理、运动管理、生活方式干预、健康教育8个方面内容。结论该研究总结了终末期糖尿病肾病血液透析患者血糖全程管理的最佳证据, 为医护人员临床实践提供全面的循证依据。     

炎症性肠病患者疲乏非药物干预的最佳证据总结

目的 检索并筛选炎症性肠病(IBD)患者疲乏非药物干预的相关证据并汇总最佳证据。方法 系统检索BMJ Best Practice、UpToDate、世界胃肠病组织网、医脉通、Cochrane Library、PubMed、CINAHL、中国知网、万方数据库等关于IBD疲乏筛查与干预的证据，包括指南、最佳实践、专家共识、系统评价等。文献质量评价由2名研究者独立进行，并提取和汇总相关证据。检索时限为建库至2022年3月25日。结果 共纳入14篇文献，其中指南3篇、专家共识1篇、最佳实践1篇、系统评价9篇，最终综合成3个层面，疲乏筛查、症状评估及再评估、非药物干预共16条相关证据。结论 本研究总结了IBD疲乏筛查、评估及再评估和非药物干预的最佳证据总结，为临床医护人员实施疲乏管理提供了循证依据。     

老年股骨颈骨折病人行人工髋关节置换术后下肢深静脉血栓预防及管理的最佳证据总结

目的:检索和获取国内外预防及管理老年股骨颈骨折病人行人工髋关节置换术后下肢深静脉血栓(DVT)的最佳证据,为临床医护人员、管理者、病人及家属提供防护支持.方法:选择PIPOST模式构建循证问题,制定严密检索策略及纳入排除标准,计算机检索老年股骨颈骨折病人行人工髋关节置换术后DVT预防及管理的相关证据,筛选符合纳入标准的所有文献.由2～3名专业研究者借助科学评价工具提取证据、评价质量及汇总.结果:共纳入11篇文献,其中4篇试验研究,2篇指南,2篇实验研究,1篇系统评价,2篇专家共识,最终汇总15条最佳证据,分别为DVT评估、诊断与筛查、高危因素、干预对策、预防管理时机及方法、健康指导6个方面.结论:护理管理者需加强护理人员老年股骨颈骨折病人行人工髋关节置换术后DVT临床预防和管理,并予以相关培训,结合医疗机构自身临床环境、护理人员知信行判断及病人意愿针对性选择证据.     

After Gestational Diabetes: An Overlooked Care Transition in Primary Care

Women with history of gestational diabetes mellitus (GDM) have significant risk for developing type 2 diabetes (T2D), especially within 6 years of giving birth. Children exposed to GDM-complicated pregnancies may also experience future metabolic abnormalities. Care transitions following GDM-complicated pregnancies are often fragmented resulting in missed opportunities to implement T2D prevention strategies. Primary care providers of women with history of GDM and their children have opportunities to deliver transgenerational health promotion interventions encompassing: T2D screening, reproductive life planning, lifestyle changes to support reduction of GDM-related metabolic risks, self-advocacy for lifelong T2D screening, weight management, and promotion of breastfeeding.     

妊娠期糖尿病孕妇产后转归及保健情况调查

目的：了解妊娠期糖尿病（GDM）孕妇产后2年转归情况、保健现状和产后保健需求,为完善GDM孕妇产后保健、减少不良转归提供参考。方法：通过便利抽样对2年内在天津市某三级甲等医院产科分娩的妊娠期糖尿病孕妇产后转归现状及保健需求进行问卷调查。结果：13.6%GDM孕妇出现产后体质量滞留;56.5%GDM孕妇产后从未监测过血糖,4.2%GDM孕妇在产后不同时间出现了糖耐量受损,1例GDM孕妇产后2年内已确诊2型糖尿病;59.7%GDM孕妇在产后42天内进行了产后保健,34.6%GDM孕妇从未进行过产后保健,36.1%GDM孕妇没有得到任何相关专业人士的指导;GDM孕妇更希望由妇产科医生、助产士、社区保健医生通过孕妇学校课程、宣传手册、微信公众号等线上形式提供新生儿保健指导、膳食指导、运动指导、主要照护者健康教育等保健内容。结论：目前GDM孕妇对血糖变化重视程度较低,自我监测意识较差;产后保健不够系统、规范,未来应进一步加强筛查与管理,以减少GDM产后不良转归的发生。     

Postpartum glucose screening among women with gestational diabetes

Objective(1) Determine the rate of completion of glucose screening for diabetes in the postpartum period for women who had gestational diabetes mellitus, and (2) compare the rates of follow up glucose screening among women who had A1GDM or A2GDM 4-12 weeks postoartum.DesignA retrospective comparative study.SettingAn academic hospital in an urban community.ParticipantsOne hundred and seventy-five women with gestational diabetes who gave birth between January 2012 and September 2015.MethodsThe electronic medical record was reviewed to confirm diagnosis of gestational diabetes at 24–28 weeks and completion of 4–12 weeks postpartum glucose screening. All consecutive women meeting eligibility criteria were included.ResultsThe rate of postpartum glucose screening was 38.9%. There were 22 (31.0%) women with A1GDM and 46 (44.2%) women with A2GDM who had postpartum glucose screening (χ² = 3.12, p = 0.08).ConclusionsThe type of GDM, did not affect the rate of follow-up for postpartum glucose screening. Strategies need to be developed to improve postpartum screening rates in women with gestational diabetes.     

A pregnancy and postpartum lifestyle intervention in women with gestational diabetes mellitus reduces diabetes risk factors: a feasibility randomized control trial

OBJECTIVE

To pilot, among women with gestational diabetes mellitus (GDM), the feasibility of a prenatal/postpartum intervention to modify diet and physical activity similar to the Diabetes Prevention Program. The intervention was delivered by telephone, and support for breastfeeding was addressed.

RESEARCH DESIGN AND METHODS

The goal was to help women return to their prepregnancy weight, if it was normal, or achieve a 5% reduction from prepregnancy weight if overweight. Eligible participants were identified shortly after a GDM diagnosis; 83.8% consented to be randomly assigned to intervention or usual medical care (96 and 101 women, respectively). The retention was 85.2% at 12 months postpartum.

RESULTS

The proportion of women who reached the postpartum weight goal was higher, although not statistically significant, in the intervention condition than among usual care (37.5 vs. 21.4%, absolute difference 16.1%, P = 0.07). The intervention was more effective among women who did not exceed the recommended gestational weight gain (difference in the proportion of women meeting the weight goals: 22.5%, P = 0.04). The intervention condition decreased dietary fat intake more than the usual care (condition difference in the mean change in percent of calories from fat: −3.6%, P = 0.002) and increased breastfeeding, although not significantly (condition difference in proportion: 15.0%, P = 0.09). No differences in postpartum physical activity were observed between conditions.

CONCLUSIONS

This study suggests that a lifestyle intervention that starts during pregnancy and continues postpartum is feasible and may prevent pregnancy weight retention and help overweight women lose weight. Strategies to help postpartum women overcome barriers to increasing physical activity are needed.Gestational diabetes mellitus (GDM) is glucose intolerance with onset or first diagnosis during pregnancy (1). GDM complicates between 7–14% of pregnancies in the U.S. (1), and its incidence has increased 35–100% (2). A history of GDM is one of the strongest risk factors for type 2 diabetes (3). Among women with a history of GDM, the cumulative risk of developing type 2 diabetes at 10 years postpartum ranges from 20 to 50% (4,5). There is strong evidence from efficacy trials in at-risk individuals (6–8) that type 2 diabetes is preventable by lifestyle interventions focusing on weight management.Despite this evidence, no lifestyle interventions for diabetes prevention starting during pregnancy and continuing postpartum have been translated for use in women with GDM. There are several reasons for starting an intervention soon after the diagnosis of GDM. First, women who exceed the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) retain twice as much weight compared with women who gain within the recommendations (9), and this is associated with an increased likelihood of long-term obesity (9–11). Second, a lifestyle intervention that starts soon after the diagnosis of GDM takes advantage of the “teachable moment” of pregnancy; women with GDM may be concerned about their children’s increased risk of adverse health outcomes and their own increased risk of diabetes, which could motivate the adoption of preventive behaviors. Third, GDM patients’ frequent interactions with the health care system during and after pregnancy present an opportunity for such an intervention to be adopted by the health care system. However, participation in such an intervention may not be feasible for women with young children who are also likely to work outside home.The aim of this randomized pilot trial was to evaluate the feasibility of a lifestyle intervention initiated soon after the diagnosis of GDM and continuing postpartum. The primary goals of the intervention were to help women return to their pregravid weight if normal weight before pregnancy or achieve a 5% reduction from their pregravid weight if overweight or obese before pregnancy. The intervention curriculum was adapted from the Diabetes Prevention Program (DPP) (12) but delivered primarily by telephone (instead of individual, in-person counseling sessions) to make it more accessible to pregnant and postpartum women and feasible for the health care system.     

Elevated homocysteine as a risk factor for the development of diabetes in women with a previous history of gestational diabetes mellitus: a 4-year prospective study

OBJECTIVE: To investigate the potential use of the plasma homocysteine level as a predictor of diabetes in women with a previous history of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: At 6 weeks' postpartum, baseline examination was performed in 177 GAD-negative subjects. Of these subjects, 7 who were diagnosed with diabetes at baseline were excluded from further evaluation, and 170 with normal or impaired glucose tolerance (IGT) at baseline were followed annually over 4 years. The follow-up examinations included 2-h 75-g oral glucose tolerance tests (OGTTs), lipid profiles, homocysteine levels, anthropometric measurements, history taking, diet, and lifestyle. During the OGTTs, insulin and glucose levels were assayed every 30 min. Plasma homocysteine levels were determined by ion-exchange chromatography. RESULTS: Of the 170 women, 18 (10.6%) converted to diabetes during the 4-year follow-up period. Mean age, BMI, fasting insulin, and total cholesterol at baseline (6 weeks' postpartum test) were similar in the three study groups (i.e., normal, IGT, and diabetes). Fasting glucose levels, insulin-to-glucose ratios, and homocysteine levels were significantly higher in the diabetic group (P < 0.05). Higher glucose at the time of the diagnosis of GDM and higher homocysteine levels at baseline were independently associated with the onset of postpartum diabetes. These relationships were independent of age, BMI, and family history of diabetes. CONCLUSIONS: This prospective study identified homocysteine level as a significant risk factor for development of diabetes in women with previous GDM.     

Early postpartum metabolic assessment in women with prior gestational diabetes.

OBJECTIVE: To present the results of early postpartum metabolic assessment in women with gestational diabetes mellitus (GDM), to determine predictive factors for subsequent diabetes, and to investigate the association of postpartum glucose tolerance with other components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: A total of 788 women were evaluated 3-6 months after a GDM pregnancy. A 75-g oral glucose tolerance test (OGTT) was performed. Cholesterol, HDL cholesterol, triglycerides, blood pressure, BMI, and body fat distribution were assessed. Clinical and obstetric history, baseline variables at the diagnosis of GDM, metabolic control during pregnancy, and index pregnancy outcome were compared in women with diabetes and women without diabetes (American Diabetes Association [ADA] criteria) after pregnancy. Multivariate logistic regression analysis was used to ascertain independent predictors of subsequent diabetes. Correlation coefficients were assessed between postpartum glucose tolerance and lipid levels, blood pressure, BMI, and body fat distribution. RESULTS: According to ADA criteria, 588 (74.6%) women were normal, 46 (5.8%) had impaired fasting glucose, 82 (10.4%) had impaired glucose tolerance, 29 (3.7%) had both impaired fasting glucose and impaired glucose tolerance, and 43 (5.4%) had diabetes. Prepregnancy obesity, recurrence of GDM, gestational age at diagnosis of GDM, glucose values in the 100-g OGTT, number of abnormal values in the 100-g OGTT, fasting C-peptide levels in pregnancy, C-peptide/glucose score in pregnancy, insulin requirement in pregnancy, 3rd trimester HbA1c levels, and macrosomia differed significantly in women with subsequent diabetes. Independent predictors of postpartum diabetes were prepregnancy obesity, C-peptide/glucose score during pregnancy, and the number of abnormal values in the 100-g diagnostic OGTT. The area under the postpartum glucose curve was positively associated with BMI, waist circumference, waist-to-hip ratio, triglycerides, and systolic and diastolic blood pressures. CONCLUSIONS: Low C-peptide/glucose score during pregnancy together with prepregnancy obesity and severity of GDM (number of abnormal values in the 100-g diagnostic OGTT) are independent predictors of subsequent diabetes. Our data suggest that regardless of obesity and severity of GDM, a beta-cell defect increases the risk of postpartum diabetes. The association of postpartum glucose tolerance with triglyceride levels, blood pressure, obesity, and regional distribution of body fat suggests that postpartum glucose intolerance anticipates a high-risk cardiovascular profile that comprises other risk factors besides diabetes.     

Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: A report from the Translating Research Into Action for Diabetes (TRIAD) Study

OBJECTIVE—The purpose of this study was to examine trends in postpartum glucose screening for women with gestational diabetes mellitus (GDM), predictors of screening, trends in postpartum impaired fasting glucose (IFG) and diabetes, and diabetes and pre-diabetes detected by postpartum fasting plasma glucose (FPG) versus a 75-g oral glucose tolerance test (OGTT).RESEARCH DESIGN AND METHODS—This was a cohort study of 14,448 GDM pregnancies delivered between 1995 and 2006. Postpartum screening was defined as performance of either an FPG or OGTT at least 6 weeks after delivery and within 1 year of delivery.RESULTS—Between 1995 and 2006, the age- and race/ethnicity-adjusted proportion of women who were screened postpartum rose from 20.7% (95% CI 17.8–23.5) to 53.8% (51.3–56.3). Older age, Asian or Hispanic race/ethnicity, higher education, earlier GDM diagnosis, use of diabetes medications during pregnancy, and more provider contacts after delivery were independent predictors of postpartum screening. Obesity and higher parity were independently associated with lower screening performance. Among women who had postpartum screening, the age- and race/ethnicity-adjusted proportion of IFG did not change over time (24.2 [95% CI 20.0–27.8] in 1995–1997 to 24.3 [22.6–26.0] in 2004–2006), but the proportion of women with diabetes decreased from 6.1 (95% CI 4.2–8.1) in 1995–1997 to 3.3 (2.6–4.0) in 2004–2006. Among women who received an OGTT in 2006, 38% of the 204 women with either diabetes or pre-diabetes were identified only by the 2-h glucose measurements.CONCLUSIONS—Postpartum screening has increased over the last decade, but it is still suboptimal. Compared with FPGs alone, the 2-h values identify a higher proportion of women with diabetes or pre-diabetes amenable to intervention.Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with onset of or first recognition during pregnancy. Postpartum diabetes screening may detect diabetes that preceded pregnancy and therefore enable early treatment of hyperglycemia, reducing the risk of adverse fetal outcomes in subsequent pregnancies (1) and maternal microvascular complications (2). Screening can also identify women who might benefit from diabetes prevention interventions (3,4).Performance rates of postpartum diabetes screening have been low (5–7), but screening performance may have changed recently. At present, only one population-based report has examined postpartum diabetes screening practices, and this report examined fasting plasma glucose (FPG) only (8). We used data from a GDM registry in a large prepaid group practice managed health care organization (the Kaiser Permanente Medical Care Program in Northern California [KPNC]) and examined 1) postpartum diabetes screening over time, 2) predictors of postpartum screening in a detailed electronic medical record, 3) trends in impaired fasting glucose (IFG) or diabetes detected with postpartum screening, and 4) the proportion of women with diabetes or pre-diabetes identified by the FPG screen versus the proportion of women with these abnormal glucose values identified by the 75-g oral glucose tolerance test (OGTT).     

Did publication of a clinical practice guideline recommendation to screen for type 2 diabetes in women with gestational diabetes change practice?

OBJECTIVE: To determine whether women with previous gestational diabetes mellitus (GDM) were screened postpartum for type 2 diabetes according to the Canadian Diabetes Association (CDA) guidelines. RESEARCH DESIGN AND METHODS: The 1998 CDA guidelines recommend that all women diagnosed with GDM be screened postpartum for type 2 diabetes using a 2-h 75-g oral glucose tolerance test (OGTT). The impact of and compliance with this expert opinion-based recommendation is unknown. All women who delivered at the Ottawa Hospital in 1997 (pre-guideline) and 2000 (post-guideline) with confirmed GDM were identified. Using population-based administrative databases, we determined the proportion of these women who had an OGTT, serum glucose test, or glycated hemoglobin (GHb) test in the first postpartum year. Women who had not undergone any blood work were excluded. RESULTS: There were 131 women in 1997 and 123 women in 2000 with confirmed GDM. Of these, only 69 women in 1997 and 52 women in 2000 had blood work recorded in the database. None of these women had an OGTT performed in either period. We found a significant increase in the measurement of serum glucose (50 women pre-guideline [72.1%], 48 women post-guideline [92.3%], P < 0.05) and GHb (8 women pre-guideline [11.6%], 20 women post-guideline [38.5%], P < 0.01). CONCLUSIONS: In our region, physicians are not following the CDA recommendations to screen women with GDM postpartum with an OGTT. However, we did find a significant increase in the measurement of serum glucose and GHb. Publication of expert opinion-based guidelines did not change the postpartum use of an OGTT in these women but may have increased the use of less reliable screening tests for type 2 diabetes.     

246例妊娠期糖尿病孕妇产后6周血糖监测状况分析

目的分析妊娠期糖尿病(GDM)孕妇产后6周行口服葡萄糖耐量试验(OGTT)状况及影响因素,探索提高产后血糖管理对策。方法回顾性分析对确诊的GDM孕妇产后行75g OGTT复查和访谈。结果2015~2019年共计孕妇建卡数2533例,2532例行OGTT确诊GDM 246例,其中170例孕妇产后6周行OGTT,51例拒绝检查,25例失访。170例中发现25例糖调节受损,2例糖尿病。51例GDM孕妇拒绝OGTT的因素分别是自测空腹血糖正常、坚信自己不会得糖尿病、害怕多次抽血、没时间、喝糖水不适及家人不支持或反对。结论GDM孕妇产后6周行OGTT是必要的,但依从性不高。建议扩大健康宣教对象,加强宣教力度,利用信息技术完善动态管理机制,妇保医生联合全科医生对GDM孕妇产后血糖管理。