University of Calgary, Calgary, Canada.
Ann Intern Med. 2013 Jul 16;159(2):115-22. doi: 10.7326/0003-4819-159-2-201307160-00657.
A 50-g oral glucose challenge test (OGCT) is a widely accepted screening method for gestational diabetes mellitus (GDM), but other options are being considered.
To systematically review the test characteristics of various screening methods for GDM across a range of recommended diagnostic glucose thresholds.
15 electronic databases from 1995 to May 2012, reference lists, Web sites of relevant organizations, and gray literature.
Two reviewers independently identified English-language prospective studies that compared any screening test for GDM with any reference standard.
One reviewer extracted and a second reviewer verified data from 51 cohort studies. Two reviewers independently assessed methodological quality.
The sensitivity, specificity, and positive and negative likelihood ratios for the OGCT at a threshold of 7.8 mmol/L (140 mg/dL) were 70% to 88%, 69% to 89%, 2.6 to 6.5, and 0.16 to 0.33, respectively. At a threshold of 7.2 mmol/L (130 mg/dL), the test characteristics were 88% to 99%, 66% to 77%, 2.7 to 4.2, and 0.02 to 0.14, respectively. For a fasting plasma glucose threshold of 4.7 mmol/L (85 mg/dL), they were 87%, 52%, 1.8, and 0.25, respectively. Glycated hemoglobin level had poorer test characteristics than fasting plasma glucose level or the OGCT. No studies compared the OGCT with International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.
The lack of a gold standard for confirming GDM limits comparisons. Few data exist for screening tests before 24 weeks' gestation.
The OGCT and fasting plasma glucose level (at a threshold of 4.7 mmol/L [85 mg/dL]) by 24 weeks' gestation are good at identifying women who do not have GDM. The OGCT is better at identifying women who have GDM. The OGCT has not been validated for the IADPSG diagnostic criteria.
50 克口服葡萄糖挑战试验（OGCT）是一种广泛接受的妊娠期糖尿病（GDM）筛查方法，但也有其他方法正在考虑中。
系统综述不同筛查方法在各种推荐诊断血糖阈值下对 GDM 的检测特性。
1995 年至 2012 年 5 月的 15 个电子数据库、参考文献列表、相关组织的网站和灰色文献。
两名审查员独立确定了比较任何 GDM 筛查试验与任何参考标准的英语前瞻性研究。
一名审查员提取数据，另一名审查员对 51 项队列研究的数据进行验证。两名审查员独立评估方法学质量。
OGCT 在阈值为 7.8mmol/L（140mg/dL）时的敏感性、特异性、阳性和阴性似然比分别为 70%至 88%、69%至 89%、2.6 至 6.5 和 0.16 至 0.33；在阈值为 7.2mmol/L（130mg/dL）时，这些指标分别为 88%至 99%、66%至 77%、2.7 至 4.2 和 0.02 至 0.14；在空腹血糖阈值为 4.7mmol/L（85mg/dL）时，这些指标分别为 87%、52%、1.8 和 0.25。糖化血红蛋白水平的检测特性比空腹血糖水平或 OGCT 差。没有研究比较 OGCT 与国际妊娠糖尿病协会和妊娠协会（IADPSG）诊断标准。
缺乏 GDM 确诊的金标准，限制了比较。24 周前妊娠的筛查试验数据较少。
OGCT 和 24 周前空腹血糖水平（阈值为 4.7mmol/L[85mg/dL]）对识别未患 GDM 的女性较为准确。OGCT 对识别患有 GDM 的女性更准确。OGCT 尚未通过 IADPSG 诊断标准验证。
