Dudhbhai Munira, Lim Louis, Bombard Allan, Juliard Kell, Meenakshi Bhillakar, Trachelenberg Yelena, Weiner Zeev
Department of Obstetrics and Gynecology, Lutheran Medical Center, Brooklyn, NY, USA.
Am J Obstet Gynecol. 2006 May;194(5):e42-5. doi: 10.1016/j.ajog.2005.11.031. Epub 2006 Apr 21.
The purpose of this study was to evaluate the characteristics and outcomes of patients who had abnormal glucose challenge test results and subsequent normal oral glucose tolerance test results and to assess whether such patients are at a greater risk than normal pregnant patients for adverse perinatal outcome.
In this retrospective cohort study that was conducted between June and December 2003, 101 pregnant women (group A) had an abnormal glucose challenge test result and a normal oral glucose tolerance test result. Data were also collected on 2 control groups: 100 pregnant women with normal glucose challenge test results (group B) and all 76 pregnant women who were diagnosed with gestational diabetes mellitus during this period of time (group C). Patients with multiple pregnancies, chronic hypertension, pregestational diabetes mellitus, or any other maternal or fetal problems that were diagnosed before 24 weeks (when the glucose challenge test was performed) were excluded from the study groups. The following data were collected and analyzed: maternal age, maternal weight and height, parity and gravidity, diabetes mellitus in first-degree relatives, medical and obstetric history, ethnicity, complications during the third trimester of pregnancy, birth weight, gestational age at delivery, mode of delivery, Apgar scores, cord blood gas results, maternal complications of labor and during the postpartum period, and infant admission to the neonatal intensive care unit. For comparison between groups, we used the Student t test, 1-way analysis of variance, the chi-square test, and stepwise logistic regression.
Patients in groups A and C were significantly older compared with group B (29.2 +/- 5.6 years and 30.4 +/- 5.5 years, respectively, vs 24.8 +/- 5.5 years; P < .01), had a lesser rate of primiparity (48% and 31%, respectively, vs 24%; P < .05), had greater body mass index (30.8 +/- 5 kg/m2 and 31.3 +/- 6 kg/m2, respectively, vs 29.2 +/- 4.4 kg/m2; P < .01), had a greater rate of previous gestational diabetes mellitus (6% and 20%, respectively, vs 0%; P < .05), and had a greater rate of first-degree family members with diabetes mellitus (21% and 21%, respectively, vs 3%; P < .01). None of the outcome parameters was statistically significant when group A was compared with group B.
Patients with an abnormal glucose challenge test result and a subsequent normal oral glucose tolerance test result have different maternal characteristics and backgrounds compared with patients in whom both test results are normal, yet both groups have normal outcomes. We should continue to consider patients who have an abnormal glucose challenge test result and subsequent normal oral glucose tolerance test result as low-risk; however, these findings may represent an indication of an increased likelihood for the development of overt diabetes mellitus later in life.
本研究旨在评估葡萄糖耐量试验结果异常但随后口服葡萄糖耐量试验结果正常的患者的特征和结局，并评估此类患者围产期不良结局的风险是否高于正常孕妇。
在这项于2003年6月至12月进行的回顾性队列研究中，101名孕妇（A组）葡萄糖耐量试验结果异常但口服葡萄糖耐量试验结果正常。还收集了2个对照组的数据：100名葡萄糖耐量试验结果正常的孕妇（B组）以及在此期间所有76名被诊断为妊娠期糖尿病的孕妇（C组）。多胎妊娠、慢性高血压、孕前糖尿病或在24周（进行葡萄糖耐量试验时）之前诊断出的任何其他母体或胎儿问题的患者被排除在研究组之外。收集并分析了以下数据：产妇年龄、产妇体重和身高、产次和妊娠次数、一级亲属中的糖尿病、病史和产科病史、种族、妊娠晚期并发症、出生体重、分娩时的孕周、分娩方式、阿氏评分、脐血气结果、分娩时及产后的母体并发症以及婴儿入住新生儿重症监护病房的情况。为了进行组间比较，我们使用了学生t检验、单因素方差分析、卡方检验和逐步逻辑回归。
与B组相比，A组和C组患者年龄显著更大（分别为29.2±5.6岁和30.4±5.5岁，而B组为24.8±5.5岁；P<.01），初产率较低（分别为48%和31%，而B组为24%；P<.05），体重指数更高（分别为30.8±5kg/m²和31.3±6kg/m²，而B组为29.2±4.4kg/m²；P<.01），既往妊娠期糖尿病发生率更高（分别为6%和20%，而B组为0%；P<.
