Rudge Marilza V C, Lima Carlos A B, Paulette Teresa A L, Jovanovic Lois, Negrato Carlos A, Rudge Cibele V C, Calderon Iracema M P, Dias Adriano, Atallah Alvaro N
Department of Gynecology, Obstetrics and Mastology, Botucatu Medical School, São Paulo State University, São Paulo, Brazil.
Endocr Pract. 2008 Sep;14(6):678-85. doi: 10.4158/EP.14.6.678.
To evaluate data from patients with normal oral glucose tolerance test (OGTT) results and a normal or impaired glycemic profile (GP) to determine whether lower cutoff values for the OGTT and GP (alone or combined) could identify pregnant women at risk for excessive fetal growth.
We classified 701 pregnant women with positive screening for gestational diabetes mellitus (GDM) into 2 categories -- (1) normal 100-g OGTT and normal GP and (2) normal 100-g OGTT and impaired GP-to evaluate the influence of lower cutoff points in a 100-g OGTT and GP (alone or in combination) for identification of pregnant women at excessive fetal growth risk. The OGTT is considered impaired if 2 or more values are above the normal range, and the GP is impaired if the fasting glucose level or at least 1 postprandial glucose value is above the normal range. To establish the criteria for the OGTT (for fasting and 1, 2, and 3 hours after an oral glucose load, respectively), we considered the mean (75 mg/dL, 120 mg/dL, 113 mg/dL, and 97 mg/dL), mean plus 1 SD (85 mg/dL, 151 mg/dL, 133 mg/dL, and 118 mg/dL), and mean plus 2 SD (95 mg/dL, 182 mg/dL, 153 mg/dL, and 139 mg/dL); and for the GP, we considered the mean and mean plus 1 SD (78 mg/dL and 92 mg/dL for fasting glucose levels and 90 mg/dL and 130 mg/dL for 1- or 2-hour postprandial glucose levels, respectively).
Subsequently, the women were reclassified according to the new cutoff points for both tests (OGTT and GP). Consideration of values, in isolation or combination, yielded 6 new diagnostic criteria. Excessive fetal growth was the response variable for analysis of the new cutoff points. Odds ratios and their respective confidence intervals were estimated, as were the sensitivity and specificity related to diagnosis of excessive fetal growth for each criterion. The new cutoff points for the tests, when used independently rather than collectively, did not help to predict excessive fetal growth in the presence of mild hyperglycemia.
Decreasing the cutoff point for the 100-g OGTT (for fasting and 1, 2, and 3 hours) to the mean (75 mg/dL, 120 mg/dL, 113 mg/dL, and 97 mg/dL) in association with the GP (mean or mean plus 1 SD-78 mg/dL and 92 mg/dL for the fasting state and 90 mg/dL and 130 mg/dL for 1- or 2-hour postprandial values-increased the sensitivity and specificity, and both criteria had statistically significant predictive power for detection of excessive fetal growth.
评估口服葡萄糖耐量试验（OGTT）结果正常且血糖谱（GP）正常或受损的患者数据，以确定OGTT和GP的较低临界值（单独或联合使用）是否能识别有胎儿生长过度风险的孕妇。
我们将701例妊娠期糖尿病（GDM）筛查阳性的孕妇分为两类：（1）100克OGTT正常且GP正常；（2）100克OGTT正常且GP受损，以评估100克OGTT和GP中较低临界值（单独或联合）对识别有胎儿生长过度风险孕妇的影响。如果两个或更多值高于正常范围，则OGTT被认为受损；如果空腹血糖水平或至少一个餐后血糖值高于正常范围，则GP受损。为确定OGTT的标准（分别针对空腹及口服葡萄糖负荷后1、2和3小时），我们考虑了均值（75毫克/分升、120毫克/分升、113毫克/分升和97毫克/分升）、均值加1个标准差（85毫克/分升、151毫克/分升、133毫克/分升和118毫克/分升）以及均值加2个标准差（95毫克/分升、182毫克/分升、153毫克/分升和139毫克/分升）；对于GP，我们考虑了均值和均值加1个标准差（空腹血糖水平分别为78毫克/分升和92毫克/分升，餐后1小时或2小时血糖水平分别为90毫克/分升和130毫克/分升）。
随后，根据两项检测（OGTT和GP）的新临界值对这些女性进行重新分类。单独或联合考虑这些值产生了6个新的诊断标准。胎儿生长过度是分析新临界值的反应变量。估计了比值比及其各自的置信区间，以及每个标准与胎儿生长过度诊断相关的敏感性和特异性。这些检测的新临界值单独使用而非联合使用时，在存在轻度高血糖的情况下无助于预测胎儿生长过度。
将100克OGTT（空腹及1、2和3小时）的临界值降至均值（75毫克/分升、120毫克/分升、113毫克/分升和97毫克/分升）并结合GP（均值或均值加1个标准差，空腹状态下为78毫克/分升和92毫克/分升，餐后1小时或2小时值为90毫克/分升和130毫克/分升）可提高敏感性和特异性，且这两个标准对检测胎儿生长过度均具有统计学显著的预测能力。
