Li Ping, Yin Yuzhu, Lin Shuo, Cui Jinhui, Zhou Shuisheng, Li Ling, Fan Jianhui
Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Endocrinology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Am J Med Sci. 2016 Apr;351(4):420-5. doi: 10.1016/j.amjms.2016.02.007. Epub 2016 Feb 8.
The present study aimed to evaluate the pregestational body mass index (preBMI) and initial fasting plasma glucose (FPG) in predicting gestational diabetes mellitus (GDM) in southern Chinese women.
A total of 327 pregnant women were recruited from the third affiliated hospital of Sun Yat-Sen University, Guangzhou, China. The preBMI and initial FPG at 16-18 weeks' gestation were measured. Oral glucose tolerance test was performed at 24-28 weeks' gestation. The sensitivity and specificity of preBMI and initial FPG as predictors for GDM were evaluated by receiver-operator characteristic curve analysis.
Both preBMI and initial FPG correlated with the 0-hour, 1-hour and 2-hour plasma glucose during oral glucose tolerance test (P < 0.05). The area under receiver-operator characteristic curve was 0.63 (95% CI: 0.57-0.68) for preBMI and 0.68 (95% CI: 0.61-0.72) for initial FPG in diagnosing GDM. The optimal cutoff for preBMI was 21.5 kg/m(2) (sensitivity 52.1% and specificity 69.2%) and 4.6 mmol/L (sensitivity 64.6% and specificity 65.2%) for initial FPG. Interestingly, the initial FPG had a better sensitivity compared to preBMI when the specificity was the same. Multivariate logistic regression analysis showed that initial FPG but not preBMI was the independent risk factor for the later development of GDM. After adjustment for the preBMI and the maternal age, the odds ratios of initial FPG and parity were 3.57 (95% CI: 1.72-7.45) and 2.11 (95% CI: 1.20-3.72).
Although both preBMI and initial FPG could be used as indicators for GDM, the initial FPG may be more suitable for predicting GDM in southern Chinese women.
本研究旨在评估孕前体重指数（preBMI）和空腹血糖（FPG）对中国南方女性妊娠期糖尿病（GDM）的预测价值。
选取中山大学附属第三医院327例孕妇，测量其孕16 - 18周时的preBMI和空腹血糖，孕24 - 28周时行口服葡萄糖耐量试验（OGTT）。采用受试者工作特征曲线（ROC）分析评估preBMI和空腹血糖预测GDM的敏感性和特异性。
preBMI和空腹血糖均与OGTT试验中0小时、1小时及2小时血糖水平相关（P < 0.05）。诊断GDM时，preBMI的ROC曲线下面积为0.63（95%可信区间：0.57 - 0.68），空腹血糖的ROC曲线下面积为0.68（95%可信区间：0.61 - 0.72）。preBMI的最佳截断值为21.5kg/m²（敏感性52.1%，特异性69.2%），空腹血糖的最佳截断值为4.6mmol/L（敏感性64.6%，特异性65.2%）。有趣的是，当特异性相同时，空腹血糖的敏感性优于preBMI。多因素logistic回归分析显示，空腹血糖而非preBMI是GDM发生的独立危险因素。校正preBMI和孕妇年龄后，空腹血糖和产次的比值比分别为3.57（95%可信区间：1.72 - 7.45）和2.11（95%可信区间：1.20 - 3.72）。
虽然preBMI和空腹血糖均可作为GDM的预测指标，但空腹血糖可能更适合用于预测中国南方女性GDM。
