Gestational diabetes: current screening and diagnosis
Bibliographic record
Abstract
Introduction: Screening and diagnosis of gestational diabetes (GDM) has beencontroversial. It have been proposed many diagnostic criteria but none of them basedon adverse pregnancy outcomes. Currently it has reached a consensus based on theresults of The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study.Objective: To review current status of screening and diagnosis of gestationaldiabetes.Methodology: PubMed, ScienceDirect, EBSCOhost and OvidSP databases were searchedfor clinical and epidemiological studies, systematic reviews, and meta-analysis usingthe key words taken from the Mesh “gestational diabetes”, “screening”, “diagnosis”carried out from 2005 to 2011.Results: 223 studies were identified, of which 61 fulfilled the inclusion criteria. Thebenefits of screening have been reviewed by task forces in Canada, the UK, and the USAand all concluded that the evidence is insufficient to make a specific recommendation.The HAPO study demonstrated that there is a continuous association of maternalglucose levels with adverse pregnancy outcomes and served as the basis for a newset of diagnostic criteria proposed by the International Association of Diabetes andPregnancy Study Groups (IADPSG).Conclusion: The currently recommended screening is universal. The new criteria of theIADPSG propose that the diagnosis must be realized a fasting glucose level is less than126 mg / dL (5.1 - 7.0 mmol/L) but greater than 92 mg/dL also gestational diabetesis diagnosed at the first prenatal control or with at least an abnormal blood glucose inoral tolerance test with 75 g of glucose performed between 24 - 28 weeks of gestation:≥ 92 mg/dL (≥ 5.1 mmol/L) fasting, ≥ 180 mg/dL (≥ 10.0 mmol/dL) at one hour or ≥153 mg/dL ((≥ 8.5 mmol/dL ) at two hours after. Women should be screen for overtdiabetes at their initial prenatal visit.RESUMEN:Introducción: el tamizaje y diagnóstico de la diabetes gestacional ha sido tema decontroversia. Se han propuesto muchos criterios diagnósticos pero ninguno basado enresultados adversos del embarazo. Actualmente se han propuesto algunas pautas losresultados del estudio Hyperglycemia Adverse Pregnancy Outcome (HAPO).Objetivo: precisar el estado actual del tamizaje y el diagnóstico de la diabetesgestacional.Metodología: se revisaron las bases de datos PubMed, ScienceDirect, EBSCOhost yOvidSP en búsqueda de estudios clínicos y epidemiológicos, revisiones sistemáticas,consensos y metaanálisis con las palabras claves tomadas del Mesh: gestationaldiabetes, screening, diagnosis, en el periodo comprendido entre 2005 – 2011. Criteriosde inclusión fueron tamizaje y diagnóstico.Resultados: se identificaron 223 estudios, de los cuales 61 fueron consideradosadecuados para alcanzar el objetivo de la revisión. Los beneficios del tamizaje han sidorevisados por grupos de Canadá, Reino Unido y Estados Unidos y todos han concluidoque la evidencia es insuficiente para hacer una recomendación puntual. El estudio HAPOdemostró que existe fuerte asociación entre los niveles de glucosa materna y resultadosadversos del embarazo, ello sirvió de base para un nuevo conjunto de criteriosdiagnósticos, propuestos por International Association of Diabetes and Pregnancy StudyGroups (IADPSG).Conclusión: el tamizaje más recomendado es el universal. Los nuevos criterios de laIADPSG proponen que el diagnóstico debe realizarse con una glucemia en ayunas entre92 y 126 mg/dL (5.1 – 7.0 mmol/L) en la primera consulta prenatal, o con al menos unode los siguientes valores anormales, en una prueba de tolerancia oral con 75 gramosde glucosa realizada entre las 24 - 28 semanas de gestación: glucemia en ayunas ≥ 92mg/dL (≥ 5.1 mmol/L), ≥180 mg/dl (≥ 10.0 mmol/dL) a la hora o ≥153 mg/dL (≥ 8.5mmol/dL) la dos horas. Debe buscarse diabetes pre-existente en la primera consultaprenatal.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.037 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".