Reece E A, Assimakopoulos E, Hagay Z, DeGennaro N, Zheng X Z, Hobbins J C
Department of Obstetrics and Gynecology, Yale University, School of Medicine, New Haven, Connecticut.
Obstet Gynecol Surv. 1991 Jan;46(1):1-14. doi: 10.1097/00006254-199101000-00001.
A review is given of the various methods of assessing carbohydrate tolerance in pregnancy. Oral glucose tolerance screening and diagnostic tests have been in use for more than 25 years. They are easily administered, relatively inexpensive, and present reasonable sensitivity; therefore, they continue to be used quite extensively. However, lack of reproducibility of the results and side effects such as nausea, vomiting, and headache have led to the use of alternate methods including glucose polymer (Polycose) and standard breakfast meals. These methods have been reported to present satisfactory results in clinical practice. Glycosylated hemoglobin (HbA1c) and fructosamine assays are also alternate forms of testing carbohydrate metabolism HbA1c measurement have been proven insensitive as a screening test for gestational diabetes, while their use as an index of overall glucose control remains valuable. The role of fructosamine in the assessment of carbohydrate intolerance remains controversial with conflicting claims made by various investigators regarding its sensitivity in detecting gestational diabetes and its response to alterations in glycemic control. In this review, the relative advantages and disadvantages of each glucose tolerance test are discussed and recommendations are given regarding their utility in pregnancy.
本文综述了孕期评估碳水化合物耐量的各种方法。口服葡萄糖耐量筛查和诊断试验已使用超过25年。它们操作简便、成本相对较低且具有合理的敏感性，因此仍被广泛使用。然而，结果缺乏可重复性以及恶心、呕吐和头痛等副作用，促使人们使用替代方法，包括葡萄糖聚合物（聚葡萄糖）和标准早餐餐。据报道，这些方法在临床实践中取得了令人满意的结果。糖化血红蛋白（HbA1c）和果糖胺检测也是检测碳水化合物代谢的替代形式。HbA1c测量已被证明作为妊娠期糖尿病的筛查试验不敏感，但其作为总体血糖控制指标的用途仍然很有价值。果糖胺在评估碳水化合物不耐受中的作用仍存在争议，不同研究者对其检测妊娠期糖尿病的敏感性及其对血糖控制变化的反应提出了相互矛盾的说法。在这篇综述中，讨论了每种葡萄糖耐量试验的相对优缺点，并就其在孕期的应用给出了建议。
