Watson W J
USA Hospital Berlin, APO New York, New York.
Obstet Gynecol. 1989 Jul;74(1):40-3.
To quantitate the effect of advancing pregnancy on the screening test for gestational diabetes, 550 patients were given a 50-g oral glucose screening test at 20, 28, and 34 weeks' gestation. A significant increase in the plasma glucose value was found, with a mean increase of 1.1 +/- 1.9 mg/dL per week from 20-34 weeks' gestation (r = 0.39, P less than .01). Only 34 patients (6.2%) had a positive screening test at 20 weeks' gestation, and it appears that routine screening in a low-risk population at 20 weeks is not warranted. Sixty patients (10.9%) with a negative screening test at 20 weeks had a positive test at 28 weeks. Forty-four patients (8.0%) with a negative test at 28 weeks had a subsequent positive test at 34 weeks. The overall incidence of gestational diabetes in this population was 4.9%. Currently, screening is recommended at 24-28 weeks for all pregnancies that have not been previously identified as having glucose intolerance. Eleven percent of the gestational diabetics in our population would have been undetected had we screened only at 24-28 weeks. This quantitative information may be helpful in deciding whether rescreening later in pregnancy is indicated.
为了量化孕周增加对妊娠期糖尿病筛查试验的影响，对550例患者在妊娠20、28和34周时进行了50克口服葡萄糖筛查试验。发现血糖值显著升高，从妊娠20至34周平均每周升高1.1±1.9毫克/分升（r = 0.39，P<0.01）。只有34例患者（6.2%）在妊娠20周时筛查试验呈阳性，似乎在低风险人群中于20周进行常规筛查并无必要。60例患者（10.9%）在20周时筛查试验为阴性，在28周时呈阳性。44例患者（8.0%）在28周时试验为阴性，在34周时随后呈阳性。该人群中妊娠期糖尿病的总体发病率为4.9%。目前，建议对所有先前未被确定为糖耐量异常的妊娠在24至28周进行筛查。如果我们仅在24至28周进行筛查，我们人群中11%的妊娠期糖尿病患者将会漏诊。这些定量信息可能有助于决定是否需要在妊娠后期再次进行筛查。
