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Diabetologie und Stoffwechsel 2022; 17(03): 214-224
DOI: 10.1055/a-1784-6160
Übersicht

Screening auf Gestationsdiabetes mellitus (GDM) – Welchen Weg weisen die neuen Studien? Übersicht und Kommentar

Screening on Gestational Diabetes Mellitus (GDM) – Which Way Do the New Studies Show? Review and Comment
Helmut Kleinwechter
1   Diabetes-Schwerpunktpraxis und Schulungszentrum, diabetolgikum kiel, Kiel, Germany
,
Norbert Demandt
1   Diabetes-Schwerpunktpraxis und Schulungszentrum, diabetolgikum kiel, Kiel, Germany
,
Andreas Nolte
1   Diabetes-Schwerpunktpraxis und Schulungszentrum, diabetolgikum kiel, Kiel, Germany
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Zusammenfassung

Das Screening auf Gestationsdiabetes mellitus (GDM) wird international nicht einheitlich durchgeführt. In Deutschland wird allen Schwangeren ein zweizeitiges Screening angeboten, zunächst ein 50-g Vortest (nicht nüchtern), im positiven Fall gefolgt von einem 75-g oralen Gluksetoleranztest (oGTT) über 2 h (nüchtern). Im Jahr 2021 sind zwei randomisierte Screeningstudien publiziert worden, in denen einzeitiges Screenen ohne Vortest mit dem zweizeitigen Screenen verglichen wurde. Einzeitiges Screenen erhöht die GDM-Prävalenz um das 2,3-fache ohne Vorteile für klinisch relevante Endpunkte von Müttern und Neugeborenen und um den Preis unnötiger Pharmakotherapie sowie Belastung der Ressourcen bei den Betreuern. Beim zweizeitigen Screening benötigen nur 20% der Frauen einen oGTT. Darüber hinaus wird die zweizeitige Strategie von den Frauen präferiert.

Abstract

Screening for gestational diabetes mellitus (GDM) is not carried out uniformly internationally. In Germany, all pregnant women are offered a two-stage screening, initially a 50-g pretest (not fasting), in the positive case followed by a 75-g oral glucose tolerance test (oGTT) over 2 hours (fasting). In 2021, two randomized screening studies were published in which one-stage screening without a pre-test was compared with two-stage screening. One-stage screening increases GDM prevalence 2.3-fold with no benefit for clinically relevant maternal and neonatal endpoints and at the cost of unnecessary pharmacotherapy and burden on caregiver resources. With two-stage screening, only 20% of women need an oGTT. In addition, women prefer the two-stage strategy.

Schlüsselwörter

Schwangerschaft - Glukosestoffwechsel - Diagnose - Randomisierte Studien - Metaanalyse

Keywords

pregnancy - glucose homoestasis - diagnosis - randomized Studies - metaanalysis


Publication History

Received: 01 December 2021

Accepted after revision: 21 February 2022

Article published online:
09 June 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Bundesministerium für Gesundheit. Bekanntmachung [1406 A] eines Beschlusses des Gemeinsamen Bundesausschusses über eine Änderung der Richtlinien über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung (Mutterschafts-Richtlinien): Einführung eines Screenings auf Gestationsdiabetes. BAnz. Nr. 36 (S. 914) vom 02.03.2012.
  • 2 OʼSullivan J. Gestational Diabetes. Unsuspected, Asymptomatic Diabetes in Pregnancy. N Engl J Med 1961; 264: 1082-1085
    CrossrefPubMedSearch in Google Scholar
  • 3 OʼSullivan J, Mahan C. Criteria for the Oral Glucose Tolerance Test in Pregnancy. Diabetes 1964; 13: 278-285
    PubMedSearch in Google Scholar
  • 4 Yu Y, Soohoo M, Sørensen H. et al. Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases: A Population- and Sibling-Matched Cohort Study. Diabetes Care 2021;
    CrossrefSearch in Google Scholar
  • 5 Crowther C, Hiller J, Moss J. et al. for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. N Engl J Med 2005; 352: 2477-2486
    CrossrefPubMedSearch in Google Scholar
  • 6 Landon M, Spong C, Thom E. et al. for the Eunice Kennedy Shriver Nationale Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network. A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes. N Engl J Med 2009; 361: 1339-1348
    PubMedSearch in Google Scholar
  • 7 The HAPO Study Cooperative Research Group. Hyperglycemia and Adverse Pregnancy Outcomes. N Engl J Med 2008; 358: 1991-2002
    CrossrefPubMedSearch in Google Scholar
  • 8 IADPSG Consensus Panel. International Association of Diabetes and Pregnancy Study Groups (IADPSG) Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 2010; 33: 676-682
    CrossrefPubMedSearch in Google Scholar
  • 9 Accessed November 12, 2021 at: https://apps.who.int/iris/handle/10665/85975
  • 10 Reitzle L, Schmidt C, Heidemann C. et al. Gestationsdiabetes in Deutschland: Zeitliche Entwicklung von Screeningquote und Prävalenz. J Health Monitoring 2021;
    CrossrefSearch in Google Scholar
  • 11 Corcoy R, Mendoza L, Simmons D. et al. The DALI vitamin D randomized controlled trial for gestational diabetes mellitus prevention: No major benefit shown besides vitamin D sufficiency. Clin Nutrition 2020;
    CrossrefPubMedSearch in Google Scholar
  • 12 Ghaffari N, Gonzalez J, Rosenstein M. Does the 1-step method of gestional diabetes mellitus screening improve pregnancy outcome?. AJOG MFM 2020;
    CrossrefPubMedSearch in Google Scholar
  • 13 Azeez T, Abo-Briggs T, Adeyanyu A. A systematic review and meta-analysis of the prevalence and determinants of gestational diabetes mellitus in Nigeria. Indian J Endocr Metab 2021; 25: 182-190
    CrossrefPubMedSearch in Google Scholar
  • 14 Moses R, Morris G, Petocz P. et al. The impact of potential new diagnostic criteria on the prevalence of gestational diabetes mellitus in Australia. Med J Aust 2011; 194: 338-340
    CrossrefPubMedSearch in Google Scholar
  • 15 Brown F, Wyckoff J. Application of One-Step IADPSG Versus Two-Step Diagnostic Criteria for Gestational Diabetes in the Real World: Impact on Health Services, Clinical Care, and Outcomes. Cur Diab Rep 2017;
    CrossrefPubMedSearch in Google Scholar
  • 16 US Preventive Se, rvices Task Force. Actions to Transform US Preventive Services Task Force Methods to Mitigate Systemic Racism in Clinical Preventive Services. JAMA 2021;
    CrossrefPubMedSearch in Google Scholar
  • 17 Hillier T, Pedula K, Ogasawara K. et al. A Pragmatic Randomized Clinical Trial of Gestational Diabetes Screening. N Engl J Med 2021; 384: 895-904
    CrossrefPubMedSearch in Google Scholar
  • 18 Hillier T, Pedula K, Ogasawara K. et al. A Pragmatic Randomized Clinical Trial of Gestational Diabetes Screening. N Engl J Med 2021; 384: 895-904
    CrossrefPubMedSearch in Google Scholar
  • 19 Casey B. (Ed.) Gestational Diabetes – On Broadening the Diagnosis. N Engl J Med 2021; 384: 965-966
    CrossrefPubMedSearch in Google Scholar
  • 20 Wang C, Wie Y, Zhang Y. et al. Effect of regular Exercise Commenced in Early Pregnancy on the Incidence of Gestational Diabetes Mellitus in Overweight and Obese Pregnant Women: A Randomized Controlled Trial. Diabetes Care 2016; 39: e163-e164
    CrossrefPubMedSearch in Google Scholar
  • 21 Assaf-Balut C, de la Torre N, Durán A. et al. A Mediterranean diet with additional extra virgin oil and pistachios reduces the incidence of gestational diabetes mellitus (GDM): A randomized controlled trial: The St.Carlos GDM prevention study. PloS One 2017; 12: e0185873
    CrossrefPubMedSearch in Google Scholar
  • 22 Lin X, Yang T, Zhang X. et al. Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk für gestational diabetes mellitus. J Int Med Res 2020;
    CrossrefSearch in Google Scholar
  • 23 Meek C. Swings and roundabouts: time to rethink our approach to gestational diabetes diagnosis?. Diabet Med 2021;
    CrossrefSearch in Google Scholar
  • 24 Coustan D, Dyer A, Metzger B. One Step or Two Step Testing for Gestational Diabetes: Which ist Best?. Am J Obstet Gynecol 2021; 225: 634-644
    CrossrefPubMedSearch in Google Scholar
  • 25 Schäfer-Graf U, Adamczewski H, Grieshop M. et al. „A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening“. Intedisziplinäre Stellungnahme zu dem im Titel genannten Beitrag im New England Journal of Medicine. Frauenarzt 2021; 8: 573-575
    Search in Google Scholar
  • 26 Benhalima K, Van Comburgge P, Moyson C. et al. A Modified Two-Step Screening Strategy for Gestational Diabetes Mellitus Based on the 2013 WHO Criteria by Combining the Glucose Challenge Test and Clinical Risk Factors. J Clin Med 2018; 351
    CrossrefPubMedSearch in Google Scholar
  • 27 https://www.bpb.de/nachschlagen/zahlen-und-fakten/soziale-situation-in-deutschland/61646/migrationshintergrund
  • 28 Davis E, Abebe K, Simhan H. et al. Perinatal Outcomes of Two Screening Strategies for Gestational Diabetes Mellitus. A Randomized Controlled Trial. Obstet Gynecol 2021; 138: 6-15
    CrossrefPubMedSearch in Google Scholar
  • 29 Abebe K, Scifres C, Simhan H. et al. Comparison of Two Screening Strategies for Gestational Diabetes (GDM2) Trial: Design and rationale. Contemp Clin Trials 2017;
    CrossrefPubMedSearch in Google Scholar
  • 30 Accessed July 26, 2021 at: http://links-lww.com/AOG/C336
  • 31 Pillay J, Donovan L, Guitard S. et al. Screening for Gestational Diabetes. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 326: 539-562
    CrossrefPubMedSearch in Google Scholar
  • 32 American Diabetes Association. Classification and Diagnosis of Diabetes: Standards of MedicaL Care in Diabetes – 2021. Diabetes Care 2021; 44 (Suppl. 01) S15-S33
    CrossrefPubMedSearch in Google Scholar
  • 33 Thompson D, Berger H, Feig D. et al. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Diabetes and Pregnancy. Can J Diabetes 2013; 37 (Suppl. 01) S168-S183
    CrossrefPubMedSearch in Google Scholar
  • 34 Seshiah V, Das A, Balaji V. et al. For Diabetes In Pregnancy Study Group (DIPSI). Gestational Diabetes Mellitus – Guidelines. JAPI 2006; 54: 622-628
    PubMedSearch in Google Scholar
  • 35 https://www.nice.org.uk/guidance/ng3/chapter/Recommendations#gestational-diabetes
  • 36 https://www.google.com/search?channel=nrow5&client=firefox-b-d&q=adips+guidelines+gestational+diabetes+2014
  • 37 Juan J, Yang H, Su R. et al. Diagnosis of Gestational Diabetes Mellitus in China: Perspective, Progress and Prospects. Matern Fetal Med 2019;
    CrossrefSearch in Google Scholar