A recent American College of Obstetricians and Gynecologists Clinical Practice Update continues to recommend targeted (as opposed to universal) screening for pregestational diabetes, no longer recommends screening for early gestational diabetes mellitus (GDM), and provides updated guidelines for immediate postpartum testing for diabetes in patients with GDM. Here, we present data that the targeted screening paradigm, which has repeatedly been shown to fail in practice because of its complexity, no longer makes sense in the context of the high and rising prevalence of diabetes and diabetic risk factors, and we argue that the time has come for universal early pregnancy screening for pregestational diabetes. Furthermore, the recommendation against early screening for GDM is based on 2021 U.S. Preventive Services Task Force guidance, which in turn is based almost entirely on a single underpowered study that excluded individuals at highest risk and does not account for more recent research showing benefits of early diagnosis and treatment. Universal early pregnancy screening for pregestational diabetes may also help to identify patients at risk who will benefit from early GDM diagnosis and treatment and may provide rationale for prioritizing postpartum diabetes testing.

中文翻译：

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挑战美国妇产科医师学会关于筛查既往糖尿病和早期妊娠糖尿病的临床实践更新。


最近的美国妇产科医师学会临床实践更新继续推荐对孕前糖尿病进行靶向（而不是普遍）筛查，不再推荐筛查早期妊娠糖尿病 （GDM），并为 GDM 患者的产后立即糖尿病检测提供了更新指南。在这里，我们提供了数据，表明由于其复杂性而在实践中一再被证明失败的靶向筛查范式在糖尿病和糖尿病风险因素的高患病率和上升的背景下不再有意义，我们认为现在是普遍的早期妊娠筛查孕前糖尿病的时候了。此外，反对早期筛查 GDM 的建议是基于 2021 年美国预防服务工作组指南，而该指南又几乎完全基于一项把握度低的研究，该研究排除了最高风险的个体，并且没有考虑最近的研究显示早期诊断和治疗的好处。对孕前糖尿病进行普遍的早期妊娠筛查也可能有助于识别将从早期 GDM 诊断和治疗中受益的高危患者，并可能为优先考虑产后糖尿病检测提供理由。