調(diào)整IOM指南后對妊娠期糖尿病及糖耐量正常孕婦圍產(chǎn)結(jié)局的探討

調(diào)整IOM指南后對妊娠期糖尿病及糖耐量正常孕婦圍產(chǎn)結(jié)局的探討摘要：

妊娠期糖尿?。╣estationaldiabetesmellitus,GDM）是一種常見的妊娠并發(fā)癥，其發(fā)病與胎兒及孕婦的健康密切相關(guān)。國際糖尿病聯(lián)合會(huì)（InternationalDiabetesFederation,IDF）和國際婦產(chǎn)科聯(lián)合會(huì)（InternationalFederationofGynecologyandObstetrics,FIGO）發(fā)布的IOM指南是全球范圍內(nèi)GDM的主要診療標(biāo)準(zhǔn)。盡管該指南在臨床實(shí)踐中具有很高的可行性和實(shí)用性，但在許多國家和地區(qū)表現(xiàn)出一定的局限性。最近，根據(jù)IOM指南的臨床效果進(jìn)行了調(diào)整，其中包括GDM和糖耐量正常的孕婦在調(diào)整后的指南下催產(chǎn)率、引產(chǎn)率、新生兒住院率、新生兒重癥監(jiān)護(hù)率等圍產(chǎn)結(jié)局指標(biāo)的變化。本文在對IOM指南進(jìn)行回顧的基礎(chǔ)上，探討了調(diào)整后對妊娠期糖尿病及糖耐量正常孕婦圍產(chǎn)結(jié)局的影響，同時(shí)將一些可供選擇的參考標(biāo)準(zhǔn)進(jìn)行了評估。

關(guān)鍵詞：妊娠期糖尿??；糖耐量正常；IOM指南；圍產(chǎn)結(jié)局

Introduction：

妊娠期糖尿病（gestationaldiabetesmellitus，GDM）是指在妊娠期間發(fā)生的胰島素抵抗或胰島素分泌缺陷，導(dǎo)致妊娠期高血糖的一種疾病，其診斷標(biāo)準(zhǔn)與治療方案一直是備受爭議的。目前，國際糖尿病聯(lián)合會(huì)（InternationalDiabetesFederation,IDF）和國際婦產(chǎn)科聯(lián)合會(huì)（InternationalFederationofGynecologyandObstetrics,FIGO）共同發(fā)布的IOM指南是全球范圍內(nèi)GDM的主要診療標(biāo)準(zhǔn)。盡管該指南在臨床實(shí)踐中具有很高的可行性和實(shí)用性，但在不同國家和地區(qū)表現(xiàn)出一定的局限性。最近，根據(jù)IOM指南的臨床效果進(jìn)行了調(diào)整，在調(diào)整后的指南下，針對GDM和糖耐量正常的孕婦催產(chǎn)率、引產(chǎn)率、新生兒住院率、新生兒重癥監(jiān)護(hù)率等圍產(chǎn)結(jié)局指標(biāo)進(jìn)行了分析和評估。本文將在對IOM指南進(jìn)行回顧的基礎(chǔ)上，探討調(diào)整后對圍產(chǎn)結(jié)局的影響，同時(shí)對一些可供選擇的參考標(biāo)準(zhǔn)進(jìn)行了評估。

Methods：

通過對PubMed、WebofScience、CochraneLibrary以及中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫（ChinaNationalKnowledgeInfrastructure，CNKI）等數(shù)據(jù)庫的檢索，以“妊娠期糖尿病”、“IOM指南”、“圍產(chǎn)結(jié)局”、“催產(chǎn)率”、“引產(chǎn)率”、“新生兒住院率”、“新生兒重癥監(jiān)護(hù)率”等關(guān)鍵詞進(jìn)行組合或獨(dú)立檢索，篩選出符合要求的文獻(xiàn)進(jìn)行回顧和分析。

Results：

GDM和糖耐量正常的孕婦在調(diào)整后的IOM指南中，催產(chǎn)率、引產(chǎn)率、新生兒住院率、新生兒重癥監(jiān)護(hù)率等圍產(chǎn)結(jié)局指標(biāo)相對于原指南下有所改變。盡管在不同地區(qū)和不同背景下，具體指標(biāo)的變化存在一定的差異，但總體來看，IOM指南對GDM及糖耐量正常的孕婦圍產(chǎn)結(jié)局的管理和維護(hù)仍然具有重要意義。除此之外，IOM指南在某些方面仍存在一定局限性，需要進(jìn)一步研究和改進(jìn)。

Conclusion：

在治療和管理妊娠期糖尿病和糖耐量正常孕婦的過程中，調(diào)整后的IOM指南是一個(gè)可供選擇的參考標(biāo)準(zhǔn)。然而，該指南在某些方面仍然存在依據(jù)的局限性，需要針對不同背景和地區(qū)進(jìn)行個(gè)性化調(diào)整和優(yōu)化。此外，進(jìn)一步評估其他可供選擇的參考標(biāo)準(zhǔn)對妊娠期糖尿病及糖耐量正常的孕婦的治療和管理也是非常重要的Introduction：

Gestationaldiabetesmellitus(GDM)isacommoncomplicationduringpregnancy,affectingapproximately7%ofpregnanciesworldwide.Itisassociatedwithadversematernalandfetaloutcomes,includingpreeclampsia,macrosomia,andneonatalhypoglycemia.TheInstituteofMedicine(IOM)developedguidelinesin1990forthediagnosisandmanagementofGDM.However,theseguidelineswereconsideredtobetoorestrictiveandresultedinovertreatmentofpregnantwomen.In2013,theIOMreleasednewguidelineswithrevisedcriteriaforthediagnosisofGDMandrecommendationsformanagement.ThepurposeofthisreviewistoevaluatetheimpactoftheIOMguidelinesonperinataloutcomesinwomenwithGDMornormalglucosetoleranceduringpregnancy.

Methods：

AliteraturesearchwasconductedusingdatabasessuchasChinaNationalKnowledgeInfrastructure(CNKI)usingkeywordssuchas"gestationaldiabetesmellitus,""IOMguidelines,""perinataloutcomes,""inductionoflabor,""cesareandelivery,""neonatalhospitalizationrate,"and"neonatalintensivecareunitadmissionrate."Studiesthatmettheinclusioncriteriawerereviewedandanalyzed.

Results：

TherevisedIOMguidelineshaveledtochangesinperinataloutcomesinwomenwithGDMornormalglucosetoleranceduringpregnancy.Inductionoflabor,cesareandelivery,neonatalhospitalizationrate,andneonatalintensivecareunitadmissionratewereamongtheoutcomesthatshowedchangescomparedtothepreviousguidelines.Althoughthespecificchangesvariedindifferentregionsandsettings,overall,therevisedIOMguidelinesremainimportantinthemanagementandmaintenanceofperinataloutcomesinwomenwithGDMornormalglucosetoleranceduringpregnancy.However,IOMguidelinesstillhavelimitationsinsomeaspects,andfurtherresearchandimprovementareneeded.

Conclusion：

TherevisedIOMguidelinesareausefulreferencestandardforthetreatmentandmanagementofGDMandnormalglucosetoleranceduringpregnancy.However,theguidelinesneedtobepersonalizedandoptimizedaccordingtodifferentbackgroundsandregions.Additionally,itisimportanttoevaluateotherreferencestandardsforthetreatmentandmanagementofGDMandnormalglucosetoleranceduringpregnancyFurthermore,inadditiontotheguidelines,thereneedstobemoreemphasisonpatienteducationandself-managementofGDM.Thisincludespromotinghealthylifestylebehaviorssuchasregularphysicalactivity,balancednutrition,andstressmanagement.

Itisalsoimportanttoaddressthepotentiallong-termhealthconsequencesforboththemotherandinfantfollowingGDM.StudieshavesuggestedthatwomenwithGDMhaveanincreasedriskfordevelopingtype2diabetesandcardiovasculardiseaselaterinlife.Additionally,infantsborntomotherswithGDMhaveahigherriskforobesityandmetabolicdisorders.

FutureresearchshouldfocusonoptimizingGDMtreatmentandmanagementtominimizetheserisksandimprovelong-termhealthoutcomesforbothmothersandbabies.Thisincludesinvestigatingnewinterventionssuchastelehealthandremotemonitoring,aswellasexploringthepotentialofusingpersonalizedmedicinetotailortreatmentplansbasedonindividualpatientcharacteristics.

Inconclusion,whiletherevisedIOMguidelinesprovideausefulreferencestandardforthetreatmentandmanagementofGDM,thereisstillmuchworktobedoneinoptimizingcareforpregnantwomenwithGDM.Thisincludespersonalizedtreatmentplans,emphasisonpatienteducationandself-management,andaddressingthepotentiallong-termhealthconsequencesforbothmothersandbabies.ByfurtherresearchingandimprovingGDMcare,wecanstrivetowardsimprovingthehealthoutcomesofpregnantwomenandtheiroffspringOneareathatrequiresfurtherattentioninthemanagementofGDMisthedevelopmentofpersonalizedtreatmentplans.Whilethecurrentguidelinesprovideaframeworkforcare,everywomanwithGDMisuniqueandmayrequireindividualizedtreatmentbasedonhermedicalhistory,lifestylefactors,andpersonalpreferences.Therefore,healthcareprovidersshouldworkcollaborativelywithwomenwithGDMtodevelopcareplansthataddresstheirspecificneedsandgoals.

Inadditiontopersonalizedtreatmentplans,patienteducationandself-managementplaycriticalrolesintheeffectivemanagementofGDM.PregnantwomenwithGDMshouldhaveaccesstoateamofhealthcareproviderswhocanprovidecomprehensiveeducationonthecondition,includingitscausesandpotentialcomplications,treatmentoptions,andlifestylemodifications.Patientsshouldalsobeempoweredtomonitortheirbloodglucoselevelsregularlyandadjusttheirtreatmentplansasnecessaryinconsultationwiththeirhealthcareproviders.

Finally,itisessentialtoaddressthepotentiallong-termhealthconsequencesofGDMforbothmothersandbabies.WomenwithGDMareatincreasedriskfordevelopingtype2diabetes,cardiovasculardisease,andotherhealthconditionslaterinlife.BabiesborntomotherswithGDMmaybeatincreasedriskformacrosomia(largesizeatbirth),birthinjuries,andneonatalhypoglycemia(lowbloodglucoselevels).Therefore,healthcareprovidersshouldworkwithwomenwithGDMtodevelopstrategiesforpreventingormanagingtheselong-termhealthconsequences.

Inconclusion,whilethecurrentguidelinesprovideanimportantframeworkforthecareofGDM,thereisstillmuchworktobedoneinoptimizingcareforpregnantwomenwiththiscondition.Bydevelopingpersonalizedtreatmentplans,emphasizingpatienteducationandself-management,andaddressingthepotentiallong-