妊娠期糖尿病患者产后管理的最佳证据总结

doi:10.3761/j.issn.0254-1769.2024.06.007

摘要/Abstract

摘要：

目的系统检索、提取并汇总妊娠期糖尿病（gestational diabetes mellitus，GDM）患者产后管理的最佳证据，为临床制订基于循证证据的GDM患者产后管理决策和干预措施提供依据。方法根据“6S”证据模型，系统检索国内外计算机决策支持系统、指南网站、数据库、相关专业协会网站中关于GDM患者产后管理的证据，包括指南、证据总结、临床决策、专家共识、系统评价等。检索时限为建库至2023年4月。由2名研究人员独立进行文献筛选和质量评价，根据主题进行证据提取、归纳和汇总。结果最终纳入16篇文献，包括9篇指南、5篇系统评价和2篇专家共识。通过2名研究人员共同讨论，从母乳喂养、产后药物使用的注意事项、生活方式干预、产后随访与筛查、避孕以及再次妊娠6个方面，汇总了32条有关GDM患者产后管理的相关证据。结论该研究总结了GDM患者产后管理的最佳证据，为临床开展有针对性的证据应用提供循证依据。

关键词: 妊娠期糖尿病, 产后, 证据总结, 循证护理学, 产科护理

Abstract:

Objective To provide solid evidence for clinical development and implementation of maternal postpartum management of gestational diabetes mellitus，we systematically retrieve，extract，summarize，and analyze the latest and the best evidence of maternal postpartum management of gestational diabetes mellitus. Methods According to the top-down principle of the evidence-based resource 6S model，a systematic search of domestic and foreign computer decision support systems，guideline websites，databases，and relevant social websites was conducted for evidence on maternal postpartum management of gestational diabetes mellitus，including clinical practice guidelines，best clinical practice information manuals，evidence summaries，expert consensuses，systematic reviews，and standards. The search time limit was from the establishment of the databases to April 2023. 2 trained researchers in systematic evidence-based knowledge evaluated the quality of the literature，combined with professional judgment，selected the literature that met the inclusion and exclusion criteria，and extracted the evidence. Results A total of 16 articles were included，including 9 guidelines，5 systematic reviews，and 2 expert consensus articles. The best evidence includes 32 recommendations in 6 aspects：breastfeeding，postpartum medication precautions，lifestyle，postpartum follow-up and screening，contraception，and repeat pregnancy. Conclusion The study summarizes the best evidence for postpartum management of women with gestational diabetes，and provides an evidence-based basis for targeted application of evidence by clinical healthcare providers.

Key words: Gestational Diabetes Mellitus, Postpartum, Evidence Summary, Evidence-Based Nursing, Obstetrical Nursing

王巧松, 张坤, 郑奇容, 林菁菁, 张雪玲, 方艳, 杨静萍, 林蓉, 林蓉金. 妊娠期糖尿病患者产后管理的最佳证据总结[J]. 中华护理杂志, 2024, 59(6): 691-698.

WANG Qiaosong, ZHANG Kun, ZHENG Qirong, LIN Jingjing, ZHANG Xueling, FANG Yan, YANG Jingping, LIN Rong, LIN Rongjin. Evidence summary for maternal postpartum management of gestational diabetes mellitus[J]. Chinese Journal of Nursing, 2024, 59(6): 691-698.

图/表 3

表1 纳入文献的基本特征（n=16）

Table 1 Characteristics of the included studies（n=16）

表2 指南的质量评价结果（n=9）

Table 2 Quality assessment of included guidelines（n=9）

表3 妊娠期糖尿病患者产后管理的最佳证据总结

Table 3 Evidence summary for maternal postpartum management of gestational diabetes mellitus

参考文献 42

[1]	McCarthy KJ, Liu SH, Huynh M, et al. Influence of gestational diabetes mellitus on diabetes risk and glycemic control in a retrospective population-based cohort[J]. Diabetes Care, 2023, 46(8):1483-1491. DOI PMID
[2]	Hui, Wang. IDF diabetes atlas:estimation of global and regional gestational diabetes mellitus prevalence for 2021 by international association of diabetes in pregnancy study group’s criteria[J]. Diabetes Res Clin Pract, 2022, 183:109050. DOI URL
[3]	Cheng ZH, Wei YM, Li HT, et al. Gestational diabetes mellitus as an effect modifier of the association of gestational weight gain with perinatal outcomes:a prospective cohort study in China[J]. Int J Environ Res Public Health, 2022, 19(9):5615. DOI URL
[4]	章孟星, 周英凤, 钟婕. 妊娠期糖尿病临床护理实践指南的整合研究[J]. 中华护理杂志, 2019, 54(1):104-113.
	Zhang MX, Zhou YF, Zhong J, et al. Integrated study on clinical nursing practice guide for gestational diabetes[J]. Chin J Nurs, 2019, 54(1):104-113
[5]	You HX, Hu J, Liu Y, et al. Risk of type 2 diabetes mellitus after gestational diabetes mellitus:a systematic review & meta-analysis[J]. Indian J Med Res, 2021, 154(1):62-77. DOI URL
[6]	Vounzoulaki E, Khunti K, Abner SC, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes:systematic review and meta-analysis[J]. BMJ, 2020, 369:m1361.
[7]	Cronin á, Noctor E, O’ Doherty D, et al. Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus:a qualitative study[J]. Public Health, 2023, 220:99-107. DOI PMID
[8]	Ward RJ, Fryer AA, Hanna FW, et al. Inadequate postpartum screening for type 2 diabetes in women with previous gestation diabetes mellitus:a retrospective audit of practice over 17 years[J]. Int J Clin Pract, 2021, 75(9):e14447.
[9]	Sise A, Donald S, Coppell KJ, et al. Are women with gestational diabetes being screened for type 2 diabetes following pregnancy? A nationwide retrospective cohort study in Aotearoa New Zealand[J]. Diabetes Res Clin Pract, 2022, 194:110139. DOI URL
[10]	Rotem R, Salem-Yaniv S, Sandler-Rahat H, et al. Adherence to postpartum diabetes mellitus screening,do associated pregnancy complications make a difference?[J]. Diabetes Res Clin Pract, 2020, 159:107972. DOI URL
[11]	El Ouahabi H, Doubi , Boujraf S, et al. Gestational diabetes and risk of developing postpartum type 2 diabetes:how to improve follow-up?[J]. Int J Prev Med, 2019, 10:51. DOI PMID
[12]	The American Diabetes Association. 15. Management of diabetes in pregnancy:standards of care in diabetes—2023[EB/OL]. (2023-01-01) [2023-05-17]. https://diabetesjournals.org/care/article/46/Supplement_1/S254/148052/15-Management-of-Diabetes-in-Pregnancy-Standards.
[13]	Queensland Clinical Guidelines. Queensland clinical guideline:gestational diabetes mellitus(GDM)[EB/OL]. (2022-05-18) [2023-05-17]. https://www.health.qld.gov.au/__data/assets/pdf_file/0022/950503/g-gdm.pdf.
[14]	Society of Gynecologists and Obstetricians of Canada. Guideline No. 393-diabetes in pregnancy[EB/OL]. (2019-12-04) [2023-05-17]. https://doi.org/10.1016/j.jogc.2019.03.008.
[15]	American College of Obstetricians Gynecologists. Clinical management guidelines for obstetrician-gynecologists:pregestational diabetes mellitus[EB/OL]. (2018-02-01) [2023-05-17]. https://guide.medlive.cn/guideline/14938.
[16]	Joint British Diabetes Societies Care. Management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units[EB/OL]. (2017-05-30) [2023-05-17]. https://guide.medlive.cn/guideline/14276.
[17]	Medical Development Division, Ministry of Health Malaysia. Management of diabetes in pregnancy[EB/OL]. (2017-06-01) [2023-05-17]. https://guide.medlive.cn/guideline/16924.
[18]	Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics(FIGO) initiative on gestational diabetes mellitus:a pragmatic guide for diagnosis,management,and care[J]. Int J Gynaecol Obstet, 2015, 131(S3):S173-S211. DOI URL
[19]	Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy:an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2013, 98(11):4227-4249. DOI PMID
[20]	中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第二部分][J]. 中华妇产科杂志, 2022, 57(2):3-12.
	Obstetrics and Gynecology Section of the Chinese Medical Association, Chinese Society of Perinatal Medicine, Chinese Association of Maternal and Child Health Care, Gestational Diabetes Specialized Committee. Guideline of diagnosis and treatment of hyperglycemia in pregnancy(2022)[Part Ⅱ][J]. Chin J Obstet Gynecol, 2022, 57(2):3-12.
[21]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. Components of different types of evidence-based questions[J]. J Cont Nurs Edu, 2017, 32(21):1991-1994.
[22]	Dicenso A, Bayley L, Haynes RB. Accessing pre-appraised evidence:fine-tuning the 5S model into a 6S model[J]. Evid Based Nurs, 2009, 12(4):99-101. DOI PMID
[23]	Brouwers MC, Kerkvliet K, Spithoff K, et al. The AGREE reporting checklist:a tool to improve reporting of clinical practice guidelines[J]. BMJ, 2016, 352:i1152.
[24]	朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000.
	Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurs Train, 2020, 35(11):996-1000.
[25]	刘婷, 谭小雪, 徐娜飞, 等. 妊娠期糖尿病孕妇运动方案的最佳证据总结[J]. 中华护理杂志, 2020, 55(10):1514-1519. DOI
	Liu T, Tan XX, Xu NF, et al. Evidence summary of exercise regimens for patients with gestational diabetes mellitus[J]. Chin J Nurs, 2020, 55(10):1514-1519. DOI
[26]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI certificate pre-grading and certificate recommendation level system(2014 edition)[J]. J Cont Nurs Edu, 2015, 30(11):964-967.
[27]	Huang SY, Magny-Normilus C, McMahon E, et al. Systematic review of lifestyle interventions for gestational diabetes mellitus in pregnancy and the postpartum period[J]. J Obstet Gynecol Neonatal Nurs, 2022, 51(2):115-125. DOI URL
[28]	Li NH, Yang YZ, Cui DY, et al. Effects of lifestyle intervention on long-term risk of diabetes in women with prior gestational diabetes:a systematic review and meta-analysis of randomized controlled trials[J]. Obes Rev, 2021, 22(1):e13122. DOI URL
[29]	Hewage SS, Wu SS, Neelakantan N, et al. Systematic review of effectiveness and cost-effectiveness of lifestyle interventions to improve clinical diabetes outcome measures in women with a history of GDM[J]. Clin Nutr ESPEN, 2020, 35:20-29. DOI PMID
[30]	石志宜, 顾平, 司曼丽, 等. 生活方式干预预防妊娠期糖尿病孕妇产后发生2型糖尿病风险的系统评价[J]. 护理研究, 2018, 32(9):1415-1422.
	Shi ZY, Gu P, Si ML, et al. Risk of type 2 diabetes in pregnant women with gestational diabetes during pregnancy under lifestyle intervention:a systematic evaluation[J]. Chin Nurs Res, 2018, 32(9):1415-1422.
[31]	Guo J, Chen JL, Whittemore R, et al. Postpartum lifestyle interventions to prevent type 2 diabetes among women with history of gestational diabetes:a systematic review of randomized clinical trials[J]. J Womens Health (Larchmt), 2016, 25(1):38-49. DOI URL
[32]	周英凤, 章孟星, 李丽, 等. 《妊娠期糖尿病临床护理实践指南》推荐意见专家共识[J]. 护理研究, 2020, 34(24):4313-4318.
	Zhou YF, Zhang MX, Li L, et al. Expert consensus study on recommendations of clinical nursing practice guidelines for gestational diabetes mellitus[J]. Nurs Res, 2020, 34(24):4313-4318.
[33]	黄娜, 周英凤, 章孟星, 等. 妊娠期糖尿病临床护理实践指南的更新[J]. 护士进修杂志, 2021, 36(21):1937-1943.
	Huang N, Zhou YF, Zhang MX, et al. Update of clinical nursing practice guideline for gestational diabetes mellitus[J]. J Nurs Train, 2021, 36(21):1937-1943.
[34]	杭琳, 张洁苹, 项丹玉, 等. 基于共同养育理论的母乳喂养支持方案在NICU早产儿医院-家庭过渡期中的应用[J]. 中华护理杂志, 2023, 58(12):1435-1441. DOI
	Hang L, Zhang JP, Xiang DY, et al. Application of an intervention based on co-parenting theory on hospital-home transitional breastfeeding of NICU preterm infants[J]. Chin J Nurs, 2023, 58(12):1435-1441. DOI
[35]	Ley SH, Chavarro JE, Li MY, et al. Lactation duration and long-term risk for incident type 2 diabetes in women with a history of gestational diabetes mellitus[J]. Diabetes Care, 2020, 43(4):793-798. DOI PMID
[36]	World Health Organization. Guideline:counselling of women to improve breastfeeding practices[EB/OL]. (2019-02-11) [2023-11-14]. https://iris.who.int/handle/10665/280133.
[37]	李佳鑫, 郑雅宁, 陈雁. 妊娠期糖尿病产妇对其疾病和母乳喂养知识及态度的现状调查[J]. 中国计划生育学杂志, 2022, 30(11):2434-2442.
	Li JX, Zheng YN, Chen Y. Investigation of the knowledge about diseases and breastfeeding,and the attitude for infant feeding of women with gestational diabetes mellitus[J]. Chin J Fam Plan, 2022, 30(11):2434-2442.
[38]	周荣娟, 潘聪女. 妊娠期糖尿病患者产后发生血糖波动的相关因素分析[J]. 中国妇幼保健, 2022, 37(1):120-123.
	Zhou RJ, Pan CN. Analysis of related factors of postpartum blood glucose fluctuation in patients with gestational diabetes mellitus[J]. Matern Child Health Care China, 2022, 37(1):120-123.
[39]	Lowe WL Jr, Scholtens DM, Lowe LP, et al. Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity[J]. JAMA, 2018, 320(10):1005-1016. DOI PMID
[40]	Pastore I, Chiefari E, Vero R, et al. Postpartum glucose intolerance:an updated overview[J]. Endocrine, 2018, 59(3):481-494. DOI PMID
[41]	Newman C, Egan AM, Ahern T, et al. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland[J]. Diabetes Res Clin Pract, 2021, 173:108685. DOI URL
[42]	范洪媛, 燕美琴, 赵希林, 等. 健康行为互动模式在妊娠期糖尿病高危孕妇中的应用[J]. 中华护理杂志, 2022, 57(20):2445-2451. DOI
	Fan HY, Yan MQ, Zhao XL, et al. Effects of Interaction Model of Client Health Behavior in high-risk pregnant women with gestational diabetes mellitus[J]. Chin J Nurs, 2022, 57(20):2445-2451. DOI