PDF(Sci-hub)
Abstract：
Canada\'s largest national obstetric and diabetology organizations have recommended various algorithms for the screening of gestational diabetes mellitus (GDM) over the years. Though uniformity across recommendations from clinical practice guidelines (CPGs) is desirable, historically, national guidelines from Diabetes Canada (DC) and the Society of Obstetricians and Gynaecologists of Canada (SOGC) have differed. Lack of consensus has led to variation in screening approaches, rendering precise ascertainment of GDM prevalence challenging. To highlight the reason and level of disparity in Canada, we conducted a scoping review of CPGs released by DC and the SOGC over the last thirty years and distributed a survey on screening practices among Canadian physicians. Earlier CPGs were based on expert opinion, leading to different recommendations from these organizations. However, as a result of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study, disparities between DC and the SOGC no longer exist and many Canadian physicians have adopted their recent recommendations. Given that Canadian guidelines now recommend two different screening programs (one step vs. two step), lack of consensus on a single diagnostic threshold continues to exist, resulting in differing estimates of GDM prevalence. Our scoping review highlights these disparities and provides a step forward towards reaching a consensus on one unified threshold.
摘要：
多年来，加拿大最大的国家产科和糖尿病学组织推荐了各种筛查妊娠期糖尿病（GDM）的算法。尽管临床实践指南(CPGs)建议的一致性是可取的，历史上,加拿大糖尿病（DC）和加拿大妇产科医师协会（SOGC）的国家指南有所不同。缺乏共识导致了筛查方法的变化，精确确定GDM患病率具有挑战性。为了强调加拿大差异的原因和程度，我们对DC和SOGC在过去30年中发布的CPG进行了范围审查,并在加拿大医生中分发了一项筛查实践调查.早期的CPG是基于专家意见，导致这些组织提出不同的建议。然而,作为高血糖和不良妊娠结局（HAPO）研究的结果，DC和SOGC之间的差异不再存在，许多加拿大医生采纳了他们最近的建议。鉴于加拿大指南现在建议两种不同的筛查计划（一步与两步)，在单一诊断阈值上缺乏共识仍然存在，导致对GDM患病率的不同估计。我们的范围审查强调了这些差异，并朝着就一个统一的门槛达成共识迈出了一步。
