孕16周及以内进行口服葡萄糖耐量试验，可预测或排除高危组孕妇当前孕期后续发生的妊娠期糖尿病。

Oral glucose tolerance testing at gestational weeks < or =16 could predict or exclude subsequent gestational diabetes mellitus during the current pregnancy in high risk group.

作者信息

Bitó Tamás, Nyári Tibor, Kovács László, Pál Attila

机构信息

Department of Obstetrics and Gynaecology, University of Szeged, Albert Szent-Györgyi Medical and Pharmaceutical Center, Hungary.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2005 Jul 1;121(1):51-5. doi: 10.1016/j.ejogrb.2004.11.006.

DOI:10.1016/j.ejogrb.2004.11.006

PMID:15989984

Abstract

BACKGROUND

An oral glucose tolerance test with a result that is negative but close to the diagnostic cut-off in early pregnancy was hypothesized to serve as a predictor of subsequent gestational diabetes in a high risk group. The aim of the study was to determine those cut-off values of OGTT at gestational weeks < or =16, which can predict or exclude subsequent onset of GDM in a high risk group.

METHODS

Pregnant women at high risk of gestational diabetes (n = 163) underwent a 2-h, 75-g oral glucose tolerance test at gestational weeks < or =16 were analyzed in this study. In the event of a negative result, subsequent oral glucose tolerance tests were performed at gestational weeks 24-28 and 32-34. The sensitivity, the specificity, the positive and negative predictive values and the Odds ratio of the best cut-off values of fasting and postload glucose levels were calculated.

RESULTS

The best cut-off values to exclude subsequent GDM for fasting and postload glucose were 5.0 and 6.2 mmol/l, respectively. In combination, the best cut-off values were 5.3 mmol/l for fasting and 6.8 mmol/l for postload glucose, with negative predictive values of 0.97 and 0.71 and sensitivities of 96.9 and 86.3 at gestational weeks 24-28 and 32-34, respectively. Combination of these cut-off values with obesity proved to be very predictive for gestational diabetes by gestational weeks 32-34, with an Odds ratio of 6.0 [95% confidence interval: 1.7-21.0].

CONCLUSIONS

With regard to the very high negative predictive value of the method, pregnant women with glucose levels of < or =5.3 mmol/l at fasting and of < or = 6.8 mmol/l at postload in gestational weeks < or =16 should undergo subsequent oral glucose tolerance testing merely at gestational weeks 32-34. Approximately a quarter (24.5%) of the pregnant women at risk of gestational diabetes satisfied these criteria.

摘要

背景

在高危人群中，假设孕早期口服葡萄糖耐量试验结果为阴性但接近诊断临界值可作为预测随后发生妊娠期糖尿病的指标。本研究的目的是确定孕16周及以内口服葡萄糖耐量试验（OGTT）的临界值，以预测或排除高危人群随后发生妊娠期糖尿病（GDM）。

方法

本研究分析了163例妊娠期糖尿病高危孕妇在孕16周及以内进行的2小时75克口服葡萄糖耐量试验。如果结果为阴性，则在孕24 - 28周和32 - 34周进行后续口服葡萄糖耐量试验。计算空腹和负荷后血糖水平最佳临界值的敏感性、特异性、阳性和阴性预测值以及比值比。

结果

排除后续GDM的空腹和负荷后血糖最佳临界值分别为5.0和6.2 mmol/l。综合来看，最佳临界值为空腹5.3 mmol/l和负荷后6.8 mmol/l，在孕24 - 28周和32 - 34周时阴性预测值分别为0.97和0.71，敏感性分别为96.9和86.3。这些临界值与肥胖因素相结合，在孕32 - 34周时对妊娠期糖尿病具有很强的预测性，比值比为6.0[95%置信区间：1.7 - 21.0]。