妊娠期糖尿病的产后随访和管理：2018年美国妇产科医师学会和美国糖尿病协会指南相关内容解读

Postpartum follow-up and management of gestational diabetes mellitus： comments on relevant issues in American College of Obstetricians and Gynecologists （ACOG） and America Diabetes Association （ADA） guidelines in 2018

妊娠期糖尿病（gestational diabetes mellitus，GDM）是指孕前糖代谢正常，妊娠期才出现的糖尿病。GDM对母儿的近、远期影响取决于糖尿病的病情和血糖的控制水平。目前，我国已有针对GDM孕妇孕期相对规范的健康指导，在很大程度上改善了GDM孕妇的不良妊娠结局。同样的，产后规范的管理和监测对GDM妇女的远期并发症的预防也至关重要。2018年美国糖尿病协会（America Diabetes Association，ADA）和美国妇产科医师学会（American College of Obstetricians and Gynecologists，ACOG）指南建议GDM妇女在产后4~12周进行复查，复查指标主要为75 g口服葡萄糖耐量试验中的空腹和服糖后2 h血糖。对首次复查正常者，仍需每1~3年复查1次；对于首次产后复查异常者，除需增加复查频率和营养运动干预外，必要时还应给予药物治疗。

Gestational diabetes mellitus （GDM） is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Short- and long-term effects of GDM on both mother and child depend on the severity of the condition and blood sugar level. Currently, relatively standardized guidance on management of GDM in China has greatly improved maternal and infant outcomes. Moreover, standardized postpartum management and monitoring are also essential for the prevention of long-term complications in this population. The guidelines issued by America Diabetes Association （ADA） and American College of Obstetricians and Gynecologists （ACOG） in 2018 recommended that GDM patients should be followed up at 4-12 weeks postpartum for a 75 g oral glucose tolerance test. For those who is normal at the first postpartum follow up, it is necessary to have their blood glucose tested once every 1-3 years. However, for those who is abnormal, medication should also be initiated when necessary in addition to more frequent follow-ups and nutritional intervention and physical exercise.