Gestational diabetes mellitus in Europe: prevalence, current screening practice and barriers to screening. A review

Diabetic Medicine - Tập 29 Số 7 - Trang 844-854 - 2012
Brian S Buckley1, Jürgen Harreiter2, Peter Damm3, Rosa Corcoy4, Ana Chico4, David Simmons5, Akke Vellinga6, Fidelma Dunne1
1School of Medicine, National University of Ireland, Galway, Ireland
2Department of Medicine, Medizinische Universität Wien, Austria
3University Hospital of Copenhagen - Rigshospitalet, Denmark
4Institut de Recerca de L’Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
5Institute of Metabolic Science, Addenbrookes Hospital, Cambridge, UK
6Department of General Practice, National University of Ireland, Galway, Ireland

Tóm tắt

Diabet. Med. 29, 844–854 (2012)AbstractBackground  Gestational diabetes mellitus is a potentially serious condition that affects many pregnancies and its prevalence is increasing. Evidence suggests early detection and treatment improves outcomes, but this is hampered by continued disagreement and inconsistency regarding many aspects of its diagnosis.Methods  The Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus Prevention (DALI) research programme aims to promote pan‐European standards in the detection and diagnosis of gestational diabetes and to develop effective preventive interventions. To provide an overview of the context within which the programme will be conducted and its findings interpreted, systematic searching and narrative synthesis have been used to identify and review the best available European evidence relating to the prevalence of gestational diabetes, current screening practices and barriers to screening.Results  Prevalence is most often reported as 2–6% of pregnancies. Prevalence may be lower towards the Northern Atlantic seaboard of Europe and higher in the Southern Mediterranean seaboard. Screening practice and policy is inconsistent across Europe, hampered by lack of consensus on testing methods, diagnostic glycaemic thresholds and the value of routine screening. Poor clinician awareness of gestational diabetes, its diagnosis and local clinical guidelines further undermine detection of gestational diabetes.Conclusions  Europe‐wide agreement on screening approaches and diagnostic standards for gestational diabetes could lead to better detection and treatment, improved outcomes for women and children and a strengthened evidence base. There is an urgent need for well‐designed research that can inform decisions on best practice in gestational diabetes mellitus screening and diagnosis.

Từ khóa


Tài liệu tham khảo

Metzger BE, 1998, Proceedings of the Fourth International Workshop—conference on gestational diabetes mellitus, Diabetes Care, 21, B1

WHO, 1999, Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Report of a WHO consultation. Part 1: Diagnosis and Classification of Diabetes Mellitus

NICE, 2008, Antenatal Care: Routine Care for the Healthy Pregnant Woman

10.1056/NEJMoa042973

10.1056/NEJMoa0902430

10.1016/S0140-6736(09)60515-8

10.1056/NEJMe0907617

Lancet Editorial, 2008, The global challenge of diabetes, Lancet, 371

10.2337/diacare.27.2007.S88

NICE, 2008, Diabetes in Pregnancy: Management of Diabetes and its Complications from Pre‐Conception to the Post‐Natal Period

ADA, 2010, Position statement. Diagnosis and classification of diabetes mellitus, Diabetes Care, 33, S62, 10.2337/dc10-S062

10.1056/NEJMoa0707943

ADA, 2011, American Diabetes Association position statement: gestational diabetes mellitus, Diabetes Care, 34, S62

IADPSG Consensus Panel, 2010, International Association of Diabetes and Pregnancy Study Group recommendations on the diagnosis and classification of hyperglycemia in pregnancy, Diabetes Care, 33

EASD, 1996, Report of the pregnancy and neonatal care group of the European Association for the Study of Diabetes, Diabet Med, 13, S43

10.2337/diab.28.12.1039

O’Sullivan J, 1964, Criteria for the oral glucose tolerance test in pregnancy, Diabetes, 13, 278

10.3310/hta6110

10.7326/0003-4819-148-10-200805200-00008

10.3310/hta14360

10.2337/dc09-1376

Alwan N, 2009, Treatments for gestational diabetes, Cochrane Database Syst Rev, 3, CD003395

10.1136/bmj.c1395

10.1016/j.ajog.2004.11.039

10.1002/14651858.CD006674.pub2

10.1136/ebm.10.6.162-a

Centre for Reviews and Dissemination, 2008, Systematic Reviews: CRD’s Guidance for Undertaking Reviews in Health Care

10.1080/00016340701532444

10.1080/00016340601110747

10.1080/00016340500523644

Janghorbani M, 2006, Gestational diabetes mellitus in Plymouth, UK: prevalence, seasonal variation and associated factors, J Reprod Med, 51, 128

10.1067/S0002-9378(03)00601-X

2010, Studiecentrum voor Perinatale Epidemiologie

10.1016/j.diabres.2003.07.004

GargalloMA ZugastiA GarberíM BarrechegusenCO.Deteccion de diabetes gestacional en poblacion general: rentabilidad diagnostica de la aplicacion de los criterios de la ada en una zona sanitaria de Madrid(Detection of gestational diabetes in general population: diagnostic performance of the application of the ADA criteria in one health area of Madrid).Av Diabetol2004;20:168–172.

10.1016/S0014-2565(02)71008-4

Lapolla A, 2004, Epidemiology of diabetes in pregnancy: a review of Italian data, Diabetes Nutr Metab, 17, 358

Lombardo M, 2003, Diabetes gestacional: estudio prospectivo de los parametros analiticos obtenidos en el test de O’Sullivan como factores de riesgo de macrosomia y parto por cesarea (Gestational diabetes: a prospective study of the analytical parameters obtained in the O'Sullivan test as risk factors for macrosomia and cesarean delivery), Av Diabetol, 19, 65

10.1007/s00125-005-1756-9

10.1016/j.ejogrb.2004.10.008

National Institute for Health and Welfare, 2010, National Birth Register

10.1046/j.1464-5491.2000.00214.x

LiddyE AvalosG O’SullivanEP OwensL KirwanB GaffneyGet al..ATLANTIC‐DIP: the impact of gestational diabetes mellitus and impaired glucose tolerance on pregnancy outcome.Poster at the Meeting of the Irish Endocrine Society Cork Ireland 6–7 November2009.

10.1007/s00404-003-0483-z

Wójcikowski C, 2002, Ginekol Pol, 73, 811

Polish Ministry of Health, 2009, Program prewencji leczenia cukrzcy w Polsce. Zadania do realizacji w 2009 roku: Wdrożenie i prowadzenie Rejestru Chorych na Cukrzycę (dorosłych); Wdrożenie i prowadzenie Rejestru Wieku Rozwojowego (dzieci i młodzieży)

10.1016/j.jgyn.2008.06.012

Adamíková A, 2001, Vnitrní lékarství, 47, 777

10.1210/jc.2007-2301

10.1016/S1262-3636(07)70205-7

10.1016/j.diabres.2008.11.037

TulN PusenjakS OsredkarJ SpencerK Novak‐AntolicZ.Predicting complications of pregnancy with first‐trimester maternal serum free‐βhCG PAPP‐A and inhibin‐A.Prenat Diagn2003;23:990–996.

10.1157/13087368

Dores J, 2008, Registo da diabetes gestacional em 2005: a caminho de um registro nacional (Registration of gestational diabetes in 2005: towards a national registry), Rev Port Diabet, 3, 141

10.1530/eje.0.1460831

10.1016/S0002-9378(00)70222-5

10.1157/13120704

10.1080/jmf.16.6.331.337

10.2337/dc06-0635

10.1186/1471-2393-9-53

10.1111/j.1365-2753.2007.00783.x

Norman P, 2005, Improving staff understanding of gestational diabetes – use of self‐audit, Clin Gov Bull, 5, 9

10.1016/j.midw.2006.12.008

10.1016/S1262-3636(07)70260-4

10.1159/000229022

10.1016/S0020-7292(02)00149-2

10.1111/j.1600-0412.2004.00267.x

10.2337/dc07-0571

NICE, 2008, Antenatal Care: Diabetes in Pregnancy. Costing Report

10.2337/diab.40.2.S35

10.1007/s00125-011-2228-z