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A global view of hypertensive disorders and diabetes mellitus during pregnancy
Nature Reviews Endocrinology ( IF 31.0 ) Pub Date : 2022-09-15 , DOI: 10.1038/s41574-022-00734-y
Li Jiang 1 , Kun Tang 1, 2 , Laura A Magee 3 , Peter von Dadelszen 3 , Alec Ekeroma 4, 5 , Xuan Li 2 , Enyao Zhang 2 , Zulfiqar A Bhutta 1, 6, 7
Affiliation  

Two important maternal cardiometabolic disorders (CMDs), hypertensive disorders in pregnancy (HDP) (including pre-eclampsia) and gestational diabetes mellitus (GDM), result in a large disease burden for pregnant individuals worldwide. A global consensus has not been reached about the diagnostic criteria for HDP and GDM, making it challenging to assess differences in their disease burden between countries and areas. However, both diseases show an unevenly distributed disease burden for regions with a low income or middle income, or low-income and middle-income countries (LMICs), or regions with lower sociodemographic and human development indexes. In addition to many common clinical, demographic and behavioural risk factors, the development and clinical consequences of maternal CMDs are substantially influenced by the social determinants of health, such as systemic marginalization. Although progress has been occurring in the early screening and management of HDP and GDM, the accuracy and long-term effects of such screening and management programmes are still under investigation. In addition to pharmacological therapies and lifestyle modifications at the individual level, a multilevel approach in conjunction with multisector partnership should be adopted to tackle the public health issues and health inequity resulting from maternal CMDs. The current COVID-19 pandemic has disrupted health service delivery, with women with maternal CMDs being particularly vulnerable to this public health crisis.



中文翻译:

妊娠期高血压疾病和糖尿病的全球观点

两种重要的母体心脏代谢紊乱 (CMD)、妊娠期高血压疾病 (HDP)(包括先兆子痫)和妊娠糖尿病 (GDM) 给全世界的孕妇带来了沉重的疾病负担。HDP 和 GDM 的诊断标准尚未达成全球共识,因此难以评估国家和地区之间疾病负担的差异。然而,对于低收入或中等收入地区、低收入和中等收入国家 (LMIC) 或社会人口和人类发展指数较低的地区,这两种疾病都显示出疾病负担分布不均。除了许多常见的临床、人口统计学和行为风险因素外,母亲 CMD 的发展和临床后果在很大程度上受到健康社会决定因素的影响,例如系统性边缘化。尽管在 HDP 和 GDM 的早期筛查和管理方面取得了进展,但此类筛查和管理计划的准确性和长期效果仍在研究中。除了个体层面的药物治疗和生活方式改变外,还应采用多层次方法结合多部门合作来解决由孕产妇 CMD 引起的公共卫生问题和健康不公平。当前的 COVID-19 大流行扰乱了卫生服务的提供,患有 CMD 的产妇特别容易受到这场公共卫生危机的影响。这种筛查和管理方案的准确性和长期影响仍在调查中。除了个体层面的药物治疗和生活方式改变外,还应采用多层次方法结合多部门合作来解决由孕产妇 CMD 引起的公共卫生问题和健康不公平。当前的 COVID-19 大流行扰乱了卫生服务的提供,患有 CMD 的产妇特别容易受到这场公共卫生危机的影响。这种筛查和管理方案的准确性和长期影响仍在调查中。除了个体层面的药物治疗和生活方式改变外,还应采用多层次方法结合多部门合作来解决由孕产妇 CMD 引起的公共卫生问题和健康不公平。当前的 COVID-19 大流行扰乱了卫生服务的提供,患有 CMD 的产妇特别容易受到这场公共卫生危机的影响。

更新日期:2022-09-16
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