Adegbola O, Ajayi G O
Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Nigeria.
West Afr J Med. 2008 Jul;27(3):139-43.
Gestational Diabetes Mellitus (GDM) is frequently associated with adverse pregnancy outcome if not adequately managed. Prompt identification of these women requires a programme of active screening.
To determine the predictive value of the oral 50-gram glucose challenge test (GCT) in the detection of GDM.
At 24 to 28 weeks of gestation, 134 pregnant women with risk factors for GDM (test group) and another group of 134 consecutive pregnant women without risk factors for GDM (control group) were screened with 50 grams of anhydrous glucose and venous blood obtained one hour later. A diagnostic 3-hour - 100g oral glucose tolerance test (OGTT) was done for all either within one week for those with GCT > or = 130mg/dl (7.2mmol/L) or at 30 to 32 weeks of gestation for those with GCT of less than 130mg/dll
Of the 134 women in the test group 113 (84.3%) completed the study, as did 109 (81.3%) of the 134 women in the control group. The data from these women were analyzed. Gestational diabetes mellitus was found in 7 (6.2 %) of the test group and 5 (4.6 %) of the control group (p = 0.816), an overall prevalence of 12 (5.4 %) for the study. Among the women with newly diagnosed GDM, 58% had risk factors for glucose intolerance while 42% had no such risk factors. The sensitivity and negative predictive values were all 100% at screening values of 130mg/dl and 140mg/dl; while the specificity was 82.4% at 130mg/dl and 91% at 140mg/dl. This was however not statistically significant (p = 0.619).
The plasma glucose value of 140mg/dl in the GCT should be used because of its high sensitivity and higher specificity than does the 130mg/dl screening value. GDM is unlikely to be present if the venous plasma glucose level is less than 140mg/dl, one hour after administration of 50g oral glucose load at 24 to 28 weeks gestational age.
妊娠期糖尿病（GDM）若管理不当，常与不良妊娠结局相关。要及时识别这些孕妇，需要开展积极的筛查项目。
确定口服50克葡萄糖耐量试验（GCT）在检测GDM中的预测价值。
在妊娠24至28周时，对134名有GDM危险因素的孕妇（试验组）和另一组134名无GDM危险因素的连续孕妇（对照组）进行50克无水葡萄糖筛查，并于1小时后采集静脉血。对于GCT≥130mg/dl（7.2mmol/L）的孕妇，在1周内进行诊断性3小时-100克口服葡萄糖耐量试验（OGTT）；对于GCT＜130mg/dl的孕妇，在妊娠30至32周时进行OGTT。
试验组的134名女性中有113名（84.3%）完成了研究，对照组的134名女性中有109名（81.3%）完成了研究。对这些女性的数据进行了分析。试验组中有7名（6.2%）被诊断为妊娠期糖尿病，对照组中有5名（4.6%）（p = 0.816），该研究的总体患病率为12名（5.4%）。在新诊断为GDM的女性中，58%有葡萄糖不耐受的危险因素，而42%没有此类危险因素。当筛查值为130mg/dl和140mg/dl时，敏感性和阴性预测值均为100%；而当筛查值为130mg/dl时，特异性为82.4%，当筛查值为140mg/dl时，特异性为91%。然而，这在统计学上无显著差异（p = 0.619）。
应采用GCT中140mg/dl的血糖值，因为其敏感性高且特异性高于130mg/dl的筛查值。在孕24至28周口服50克葡萄糖负荷1小时后，若静脉血浆葡萄糖水平低于140mg/dl，则不太可能存在GDM。
