Ardawi M S, Nasrat H A, Jamal H S, Al-Sagaaf H M, Mustafa B E
Department of Clinical Biochemistry and Laboratory Medicine, King Abdulaziz University Hospital, College of Medicine and Allied Sciences, PO Box 9029, Jeddah 21413, Kingdom of Saudi Arabia.
Saudi Med J. 2000 Feb;21(2):155-60.
To evaluate the applicability of the 50-g glucose challenge test as a screening test for gestational diabetes mellitus in relation to pregnancy outcomes.
A prospective study was conducted on 818 Saudi pregnant females who were randomly recruited from the Antenatal Clinics at King Abdulaziz University Hospital and New Jeddah Clinic Hospital, Jeddah. All females underwent a 50-g glucose challenge test between 24-28 weeks gestation. A result for 50-g glucose challenge test was considered positive at > 7.2 mmol/L and the female was asked to undergo a 100-g oral glucose tolerance test. The diagnosis of gestational diabetes mellitus was carried out according to the National Diabetes Data Group criteria.
A total of 289 females exhibited plasma glucose level > 7.2 mmol/L following the 50-g glucose challenge test. Of the 289 females enrolled for the 100-g oral glucose tolerance test, 102 were diagnosed to have gestational diabetes mellitus (positive oral glucose tolerance test) and 187 were considered oral glucose tolerance test negative according to the National Diabetes Data Group diagnostic criteria. This gave a prevalence of gestational diabetes mellitus of 12.5%. Gestational diabetes mellitus females were significantly older in age, heavier in weight, with higher gravidity, greater percentage of operative deliveries and still-births, and heavier fetal birth weight as compared with the non-gestational diabetes mellitus group (P<0.05 in each case). The maximum sensitivity and specificity of the 50-g glucose challenge test were found to be at plasma glucose value of 7.8 mmol/L post the 50g glucose load. The sensitivity and specificity of this value was 88% and 84%, with a positive predictive value of 82%. To determine whether the values of plasma glucose after a 50-g glucose load were detecting abnormalities similar to those detected according to that of oral glucose tolerance test; the values obtained one-hour post the 50-g glucose challenge test were compared with zero-, one-, 2- and 3-hour values and also the area under the curve in the 100-g oral glucose tolerance test. Plasma glucose post the 50-g glucose challenge test showed marked correlation with oral glucose tolerance test results. This was mostly occurring at the one- and 2-hour oral glucose tolerance test values and was stronger in the gestational diabetes mellitus group and in both the gestational diabetes mellitus plus negative oral glucose tolerance test combined, than in the negative oral glucose tolerance test group on its own.
It is concluded that plasma glucose level measured one-hour post a 50-g glucose challenge test at 24-28 weeks of gestation with a cut-off value of 7.8 mmol/L is a reliable screening test for gestational diabetes mellitus in the local population studied. This test offers the best combination of ease and economy of use and reproducibility in screening for gestational diabetes mellitus.
评估50克葡萄糖耐量试验作为妊娠期糖尿病筛查试验与妊娠结局的相关性及适用性。
对从阿卜杜勒阿齐兹国王大学医院和吉达新吉达诊所医院产前诊所随机招募的818名沙特孕妇进行前瞻性研究。所有女性在妊娠24 - 28周期间接受50克葡萄糖耐量试验。50克葡萄糖耐量试验结果> 7.2 mmol/L被视为阳性，该女性需接受100克口服葡萄糖耐量试验。根据美国国家糖尿病数据组标准进行妊娠期糖尿病的诊断。
共有289名女性在50克葡萄糖耐量试验后血糖水平> 7.2 mmol/L。在参加100克口服葡萄糖耐量试验的289名女性中，根据美国国家糖尿病数据组诊断标准，102名被诊断为妊娠期糖尿病（口服葡萄糖耐量试验阳性），187名被视为口服葡萄糖耐量试验阴性。妊娠期糖尿病的患病率为12.5%。与非妊娠期糖尿病组相比，妊娠期糖尿病女性年龄显著更大、体重更重、妊娠次数更多、手术分娩和死产的百分比更高，胎儿出生体重更重（每种情况P<0.05）。发现50克葡萄糖耐量试验的最大敏感性和特异性出现在50克葡萄糖负荷后血浆葡萄糖值为7.8 mmol/L时。该值的敏感性和特异性分别为88%和84%，阳性预测值为82%。为确定50克葡萄糖负荷后血浆葡萄糖值检测到的异常是否与口服葡萄糖耐量试验检测到的异常相似；将50克葡萄糖耐量试验后1小时获得的值与0小时、1小时、2小时和3小时的值以及100克口服葡萄糖耐量试验的曲线下面积进行比较。50克葡萄糖耐量试验后的血浆葡萄糖与口服葡萄糖耐量试验结果显示出显著相关性。这种相关性主要出现在口服葡萄糖耐量试验的1小时和2小时值，在妊娠期糖尿病组以及妊娠期糖尿病加口服葡萄糖耐量试验阴性组合组中比单独的口服葡萄糖耐量试验阴性组更强。
得出结论，在妊娠24 - 28周时，50克葡萄糖耐量试验后1小时测量的血浆葡萄糖水平，截断值为7.8 mmol/L，是所研究当地人群妊娠期糖尿病的可靠筛查试验。该试验在妊娠期糖尿病筛查中提供了使用简便、经济和可重复性的最佳组合。
