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<strong>KCE</strong> reports vol. 6A Prenatale zorg 168 Study Ref Populatio n Intervention Outcome s 3. Screening for clinical conditions 3. a. Gestational diabetes mellitus Results Comments Study type - Daily suppressive acyclovir in the last 4 weeks of pregnancy may prevent recurrences of genital herpes at term. (1b) - For women presenting with recurrent genital herpes lesions at the onset of labour, the risks to the mother of caesarean section are small and should be set against the risks to the mother of caesarean section. (3) Recommended prevention of acquisition of genital herpes infection during pregnancy: - All women should be asked at their first antenatal visit if they or their male partner ever had genital herpes. Female partners of men with genital herpes, who themselves give no history of genital herpes, should be advised about reducing their risk of acquiring this infection. (4) What are the maternal and perinatal outcomes associated with gestational diabetes? Study Ref Population Intervention Outcomes Results Comments Study Mestman et al., 1972 OÊSullivan et al., 1973 4 [485] 360 pregnant women in the USA 4 [487] 187 GDM patients and 259 negative control patients in Boston, USA from 1962 to All had GTT and prednisolone GTT. All women followed up for 5 years Abnormal GTT at pregnancy Abnormal GTT five year after pregnancy GDM diagnosed with GTT Perinatal mortality (28th week of gestation to 14 days During pregnancy: 51/360 with elevated fasting blood sugar; 181/360 abnormal GTT; 90/360 positive PGTT; 38/360 normal 5 years later: with elevated fasting blood sugar, 17/51 had abnormal GTT; with abnormal GTT, 59/181 still had abnormal GTT; with positive PGTT, 12/90 had abnormal GTT; 0/38 normal had abnormal GTT GDM: 12/187 (6.4%) babies died; normal GTT: 4/259 (1.5%) babies died, p < EL EL type CH 2b CCS 3
<strong>KCE</strong> reports vol. 6A Prenatale zorg 169 Study Ref Population Intervention Outcomes Results Comments Study type EL 1970 postpartum) 0.05 Jensen et al., 4 [486] 143 women diagnosed with Retrospective study of case notes. Maternal outcomes Hypertensive disorders: 28 (20%) vs. CCS 3 2000 gestational diabetes and 143 Women screened by risk factors, in cases vs. controls 15 (11%), p = 0.046 controls (with at least one urinanalysis, and FPG. Diagnosis risk factor, but normal established if FPG or 75 OGTT Fetal outcomes in Caesarean section: 47 (33%) vs. 30 OGTT) in Denmark from met WHO criteria for diabetes cases vs. controls (21%), p = 0.033 1989 to 1996 mellitus in nonpregnant state Induced labour: 88 (62%) vs. 34 (24%), p < 0.0001 Crowther et al., 2005 (ACHOIS) 1000 women, between 24 and 34 weeks´gestation, who were screened positive for GD, from 1993 to 2003 in 18 centers (14 in Australia and 4 in the United Women with GDM were treated with diet and/or insulin Dietary advice, blood glucose monitoring and insulin therapy (as needed) (intervention group=490) vs. routine care (routine care group=510) Serious perinatal complications (death, shoulder dystocia, bone Preterm delivery: 15 (11%) vs. 7 (5%), p = 0.12 Gestational age: 39.0 µ 2 weeks vs. 39.9 µ 1.8, p < 0.0001 Ponderal index (kg/m3): 25.5 µ 2.8 vs. 24.9 µ 2.2, p = 0.05 Macrosomia (birth weight º 4500 g): 20 (14%) vs. 9 (6.3%), p = 0.049 Admission to neonatal unit: 66 (46.2%) vs. 17 (11.9%), p < 0.0001 Birth weight (corrected for gestational age), length at birth, Apgar score at 5 minutes, jaundice, congenital malformations and perinatal deaths were not significantly different Serious perinatal complications:1% vs 4%, adjusted RR 0.33, 95%CI 0.14 to 0.75, p=0.01 Admission to the neonatal nursery: 71% vs 61%, adjusted The screening procedure varied between centres RCT 1b
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NATIONALE RICHTLIJN PRENATALE ZORG:
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KCE reports 1. Effectiviteit en kos
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