Lu Yan-ping, Sun Gui-sheng, Weng Xia-yun, Mao Lun, Li Li-an
Department of Obstetrics and Gynecology, General Hospital of PLA, Beijing 100853, China.
Zhonghua Fu Chan Ke Za Zhi. 2003 Dec;38(12):729-32.
To evaluate of the glucose screening retest for gestational diabetes mellitus (GDM) during pregnancy.
A retrospective analysis of 714 pregnant women screened for GDM, between December 1, 2001, and December 31, 2002, was performed. The first glucose challenge test (GCT) was performed in 16 - 27 week and retested in 28 - 38 week. Diagnosis of GDM was based on the criteria of Dong. NDDG criteria was also discussed.
(1) 1-hour glucose value of 50 g GCT >or= 7.8 mmol/L was set as abnormal. The first 50 g GCT abnormal rate was 26.6% (190/714), and the retest abnormal rate was 35.2% (225/639). The mean age of pregnant women in 50 g GCT positive group was significantly higher than that in the negative group (P < 0.05), but there was no significant difference in family history and body mass index (BMI) between the two groups. Both the mean birth weight and the incidence of macrosomia of second 50 g GCT abnormal group were significantly higher than those in the normal group (P < 0.05). (2) By the criteria of Dong, 28 women were found to have GDM and 40 have IGT (impaired glucose tolerance) by the first 50 g GCT. New added cases included 15 GDM and 27 IGT by the retest 50 g GCT. By NDDG criteria, 14 GDM and 24 IGT cases were diagnosed by the first 50 g GCT, 5 GDM and 14 IGT cases by retest GCT. (3) The 1-hour blood glucose value [(7.3 +/- 1.6) mmol/L] in second 50 g GCT were significantly higher than those in first 50 g GCT [(6.9 +/- 1.8) mmol/L]. The results of 50 g GCT of two times were consistent in 68.1% women (normal/normal and abnormal/abnormal). There were 376 (52.7%) women whose 1-hour glucose value of the first 50 g GCT <or= 6.8 mmol/L. Among them neither GDM nor IGT were found by retest GCT. If the 1-hour glucose value of first 50 g GCT < 7.8 mmol/L (n = 524), there were 4 cases GDM and 17 cases IGT by the criteria of Dong by retest of 50 g GCT, but no GDM and only 7 cases IGT were found by NDDG criteria.
(1) Screening for GDM should be done for all pregnant women especially in big city. (2) If the NDDG criteria were used, the retest should be done for the women whose first 50 g GCT >or= 7.8 mmol/L, and the 75 g OGTT should be done directly. (3) Maternal age appears to be the most important risk factor for GDM.
评估孕期糖尿病（GDM）葡萄糖筛查复查情况。
对2001年12月1日至2002年12月31日期间筛查GDM的714名孕妇进行回顾性分析。首次葡萄糖耐量试验（GCT）在孕16 - 27周进行，复查在孕28 - 38周进行。GDM的诊断依据董氏标准，同时也讨论了美国国家糖尿病数据组（NDDG）标准。
（1）将50g GCT 1小时血糖值≥7.8mmol/L定为异常。首次50g GCT异常率为26.6%（190/714），复查异常率为35.2%（225/639）。50g GCT阳性组孕妇的平均年龄显著高于阴性组（P<0.05），但两组间家族史和体重指数（BMI）无显著差异。第二次50g GCT异常组的平均出生体重和巨大儿发生率均显著高于正常组（P<0.05）。（2）依据董氏标准，首次50g GCT发现28例GDM和40例糖耐量受损（IGT）。复查50g GCT新增GDM病例15例，IGT病例27例。按照NDDG标准，首次50g GCT诊断出14例GDM和24例IGT病例，复查GCT诊断出5例GDM和14例IGT病例。（3）第二次50g GCT的1小时血糖值[（7.3±1.6）mmol/L]显著高于首次50g GCT[（6.9±1.8）mmol/L]。68.1%的女性两次50g GCT结果一致（正常/正常和异常/异常）。376名（52.7%）女性首次50g GCT的1小时血糖值≤6.8mmol/L。复查GCT未发现其中有GDM或IGT。若首次50g GCT的1小时血糖值<7.8mmol/L（n = 524），依据董氏标准复查50g GCT发现4例GDM和17例IGT，但按照NDDG标准未发现GDM，仅发现7例IGT。
（1）所有孕妇尤其是大城市的孕妇均应进行GDM筛查。（2）若采用NDDG标准，首次50g GCT≥7.8mmol/L的女性应进行复查，且应直接进行75g口服葡萄糖耐量试验（OGTT）。（3）孕妇年龄似乎是GDM最重要的危险因素。
