Quality of guidelines on the management of diabetes in pregnancy a systematic review 英文参考文献.docVIP

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Quality of guidelines on the management of diabetes in pregnancy a systematic review 英文参考文献.doc

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Quality of guidelines on the management of diabetes in pregnancy a systematic review 英文参考文献

Greuteretal.BMCPregnancyandChildbirth2012,12:58 /1471-2393/12/58 RESEARCH ARTICLE OpenAccess Qualityofguidelinesonthemanagementof diabetesinpregnancy:asystematicreview MarjoleinJEGreuter1,NathalieMAvanEmmerik1,MauriceGAJWouters2andMauritsWvanTulder1* Abstract Background:Diabetesduringpregnancycanleadtosevererisksforbothmotherandfetuswhenitisnot managedproperly.Theuseofrigorouslydevelopedguidelineswitharobustimplementationprocesscanhavea positiveinfluenceonthemanagementofdiabetesduringpregnancy.Thisstudyaimstocompare recommendationsandassessthequalityofclinicalguidelinesongestationaldiabetesmellitus(GDM)and pre-existingdiabetesmellitusduringpregnancy. Methods:GuidelineswereselectedbysearchingPubMed,theGuidelineClearingHouseandGoogle.Allguidelines developedsince2000ondiabetesduringpregnancyinEnglishorDutchwereconsidered.Recommendationsof theguidelineswerecompared.Furthermore,thequalitywasassessedbytwoauthorsindependently,usingthe AGREEinstrument. Results:Eightguidelineswereincluded.AccordingtotheAGREEinstrument,thequalityofmostguidelineswas low.Thedomainseditorialindependence,stakeholderinvolvementandrigourofdevelopmenthadthelowest scores.Recommendationsweremainlycomparableonglycemiccontrol,preconceptionalcounselingandprenatal careandlabour.DifferencesbetweenrecommendationswerefoundforscreeningonGDMandinductionof labour. Conclusions:Thequalityofmostguidelinesconcerningthemanagementofdiabetesduringpregnancyneedsto beimproved.Amoresystematicapproachinthedevelopmentoftheseguidelines,moreattentionforupdating proceduresandpilotingoftheguidelinesandinvolvementoftargetusersandpatientsisrecommended. Keywords:Clinicalguidelines,Diabetesmellitus,Gestationaldiabetes,Pregnancy Background Middle Eastern origin have an increased risk of GDM Diabetes during pregnancy can lead to serious risks for [2-4]. After delivery, GDM usually resolves. However, bothmotherandfetus[1].Themanagementofdiabetes both mother and child have an increased risk of devel- differsbetweenwomenwithg