“一步法”和“两步法”妊娠期糖尿病筛查标准与不良妊娠结局的相关性Meta分析

A Meta-analysis in correlation between adverse pregnancy outcomes and screening criteria for gestational diabetes mellitus by "one-step" and "two-step" methods

目的系统评价"一步法""两步法"妊娠期糖尿病(GDM)筛查标准与不良妊娠结局的相关性。方法计算机检索Medline、Cochrane Controlled Register of Trials、EMBASE、中国知网及万方数据库,检索时间均从建库至2019年8月。收集采用"一步法""两步法"标准对GDM进行诊断的临床随机对照实验(RCTs),应用Rev Man5.3软件对产妇妊娠结局和围产儿结局指标进行荟萃分析,比较"一步法""两步法"标准对GDM检出率、大于胎龄儿(LGA)发生率、新生儿低血糖发生率、NICU入住率、新生儿出生体质量等妊娠结局的影响。结果最终纳入8篇研究论文,共6553例孕妇。荟萃分析结果显示,与"两步法"相比,"一步法"的GDM检出率较高(P<0.001),而LGA发生率(P=0.03)、巨大儿发生率(P=0.01)、新生儿低血糖发生率(P<0.001)、NICU入住率(P=0.009)及新生儿出生体质量(P=0.0008)均较低。结论与"两步法"相比,"一步法"存在更高的GDM检出率,也可以降低LGA、巨大儿、新生儿低血糖发生率、NICU入住率及新生儿出生体质量,可显著改善围产儿结局。

Objective To systematically evaluate the correlation between adverse pregnancy outcomes and screening criteria for gestational diabetes mellitus by " one-step" and " two-step" methods.Methods Medline,Cochrane Controlled Register of Trials,EMBASE,CNKI and Wanfang databases were searched from time of foundation to August 2019. Randomized controlled trials (RCTs) diagnosing gestational diabetes mellitus (GDM) were collected by using " one-step" and " two-step" standards.The RevMan5. 3 software was used to conduct a meta-analysis of maternal pregnancy outcome and perinatal outcome indicators,and to compare the effects of " one-step" and " two-step" standards on GDM detection rate,incidence of largest-age infants (LGA),incidence of neonatal hypoglycemia,NICU occupancy rate,neonatal birth weight and other pregnancy outcomes were compared. Results Eight RCTs literatures with 6 553 pregnant women were included in this study. Meta-analysis showed that when compared with the " two-step" method,the " one-step" method had a higher detection rate of GDM (P < 0. 001) and lower incidence rates of LGA (P = 0. 03),macrosomia (P = 0. 01),neonatal hypoglycemia (P < 0. 001),NICU occupancy rate (P = 0. 009) and neonatal birth weight (P =0. 000 8). Conclusion Compared with " two-step" method, " one-step" method has a higher detection rate of GDM,and can reduce the incidence rates of LGA,macrosomia and neonatal hypoglycemia,NICU occupancy rate and neonatal birth weight as well as significantly improve perinatal outcomes.