Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline.

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چکیده

The high prevalence of diabetes globally and its increasing frequency in women of gestational age have generated new research data on the relationship between glycaemia and pregnancy outcomes. The diagnostic criteria for hyperglycaemia in pregnancy recommended by the World Health Organization (WHO) in 1999 were not evidence-based and needed to be updated in the light of previously unavailable data. The update follows the WHO procedures for guidelines development. Systematic reviews were conducted for key questions, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of the evidence and to determine the strength of the recommendation on the diagnostic cut-off values for gestational diabetes. Where evidence was absent (diagnosis of diabetes in pregnancy) or GRADE was not deemed suitable (classification), recommendations were based on consensus. The systematic review of cohort studies showed that women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes, notably, macrosomia of newborn and pre-eclampsia, even after excluding the more severe cases of hyperglycaemia that required treatment. Treatment of gestational diabetes (GDM) is effective in reducing macrosomia, large for gestational age, shoulder dystocia and pre-eclampsia/hypertensive disorders in pregnancy. The risk reduction for these outcomes is in general large, the number need to treat is low, and the quality of evidence is adequate to justify treatment of GDM.

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عنوان ژورنال:
  • Diabetes research and clinical practice

دوره 103 3  شماره 

صفحات  -

تاریخ انتشار 2014