摘要
目的 综述妊娠期糖尿病的筛查与管理的研究进展。方法 系统检索并归纳2019-2025年国内外核心期刊中有关妊娠期糖尿病筛查、诊断、生活方式干预、药物治疗与产后管理的文献。结果 妊娠期糖尿病筛查存在一步法与两步法之争，早期筛查与治疗的价值仍在论证中；低血糖生成指数饮食、阻止高血压膳食模式（DASH）等膳食模式及饮食联合运动干预可改善血糖与部分妊娠结局；依据我国相关指南，生活方式干预后血糖未达标时胰岛素为优先推荐的药物治疗选择，二甲双胍可降低胰岛素启用率，但其对胎儿生长的影响有待观察；有妊娠期糖尿病史者产后2型糖尿病风险升高，但产后血糖筛查完成率偏低。结论 妊娠期糖尿病的筛查与管理趋向早期化、全程化，但诊断标准统一、口服降糖药长期安全性及产后随访衔接仍是待解决的关键问题。
关键词： 妊娠期糖尿病；筛查；诊断标准；生活方式干预；产后管理
Abstract
Objective To review research progress regarding the screening and management of gestational diabetes mellitus (GDM). Methods Literature published between 2019 and 2025 in core domestic and international journals concerning GDM screening, diagnosis, lifestyle interventions, pharmacological treatment, and postpartum management was systematically searched and summarized. Results There is ongoing debate regarding the “one-step” versus “two-step” screening methods for GDM, and the value of early screening and treatment is still being evaluated. Dietary patterns—such as low-glycemic-index diets and the Dietary Approaches to Stop Hypertension (DASH) diet—as well as interventions combining diet and exercise, can improve blood glucose levels and certain pregnancy outcomes. According to relevant Chinese guidelines, insulin is the preferred pharmacological treatment when blood glucose targets are not met following lifestyle interventions; while metformin can reduce the rate of insulin initiation, its impact on fetal growth requires further observation. Women with a history of GDM face an increased risk of type 2 diabetes postpartum, yet the completion rate for postpartum blood glucose screening remains low. Conclusion Screening and management strategies for GDM are shifting toward earlier intervention and comprehensive, continuous care; however, key issues—such as the standardization of diagnostic criteria, the long-term safety of oral hypoglycemic agents, and the continuity of postpartum follow-up—remain to be resolved.
Key words： Gestational diabetes mellitus; Screening; Diagnostic criteria; Lifestyle intervention; Postpartum management
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