gestational diabetes mellitus：妊娠期糖尿病

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1、GestationaldiabetesmellitusPiyawadeeWuttikonsammakit,M.D.Prevalenceofdiagnoseddiabeteshasincreased:14.5(1991)47.9cases/1000(2003)Increasingprevalenceoftype2diabetesinyoungerpeopleMaternalhyperglycemialeadstofetalhyperinsulinemia,obesity&insulinresistanceinchildhoodGDMDefinedascarbohydrateintol

2、eranceofvariableseveritywithonsetorfirstrecognitionduringpregnancySomewomenwithGDMhavepreviouslyunrecognizedovertdiabetesFastinghyperglycemiaearlyinpregnancyalmostinvariablyrepresentsovertdiabetesGDMNoconsensusregardingtheoptimalapproachUniversalorselectivescreeningPlasmaglucoseafter50gglucoset

3、est(50gmglucosechallengetest–GCT)isthebesttoidentifywomenatriskforGDMOne-stepapproachortwo-stepapproachScreeningLowrisk:bloodglucosetestingnotroutinelyrequiredifallthefollowingarepresent:MemberofanethnicgroupwithalowprevalenceofGDMNoknowndiabetesinfirst-degreerelativesAge<25yearsWeightnormalbef

4、orepregnancyWeightnormalatbirthNohistoryofabnormalglucosemetabolismNohistoryofpoorobstetricaloutcomeFifthinternationalworkshop-conferenceongestationaldiabetesAveragerisk:performbloodglucosetestingat24-28weeksusingeither:Two-stepprocedure:50-gGCT,followedbyadiagnostic100-gOGTTOne-stepprocedure:d

5、iagnostic100-gOGTTperformedonallsubjectsGDMscreeningHighrisk:Performbloodglucosetestingassoonasfeasible,suingtheproceduresdescribedaboveifoneormoreofthesearepresent:SevereobesityStrongfamilyhistoryoftype2diabetesPrevioushistoryofGDM,impairedglucosemetabolism,orglucosuriaIfGDMisnotdiagnosed,bloo

6、dglucosetestingshouldberepeatedat24-28weeksoratanytimetherearesymptomsorsignssuggestiveofhyperglycemiaGDMscreeningCriteriaNDDGcriteria(OGTT)**Carpenter-Coustancriteria(OGTT)**IADPSG(OGTT)*Fasting10595921hr1901801802hr1651551533hr145140-DiagnosisNationalDiabetesDataGroup.Classificationanddiagnos

7、isofdiabetesmellitusandothercategoriesofglucoseintolerance.Diabetes1979;28:1039-57CarpenterMW,CoustanDR.Criteriaforscreeningtestsforgestationaldiabetes.AmJObstetGynecol1982;144:768-73AmericanDiabetesAssociation.DiagnosisandClassif