Ingram Emily R, Robertson Iain K, Ogden Kathryn J, Dennis Amanda E, Campbell Joanne E, Corbould Anne M
School of Medicine and School of Health Sciences, Faculty of Health, University of Tasmania, Launceston, Tasmania, Australia.
Women's and Children's Service, Launceston General Hospital, Launceston, Tasmania, Australia.
Aust N Z J Obstet Gynaecol. 2017 Jun;57(3):272-279. doi: 10.1111/ajo.12514. Epub 2016 Aug 23.
Gestational diabetes mellitus (GDM) is associated with life-long increased risk of type 2 diabetes: affected women are advised to undergo oral glucose tolerance testing (OGTT) at 6-12 weeks postpartum, then glucose screening every 1-3 years.
We investigated whether in women with GDM, antenatal clinical factors predicted postpartum abnormal glucose tolerance and compliance with screening.
In women with GDM delivering 2007 to mid-2009 in a single hospital, antenatal/obstetric data and glucose tests at 6-12 weeks postpartum and during 5.5 years post-pregnancy were retrospectively collected. Predictors of return for testing and abnormal glucose tolerance were identified using multivariate analysis.
Of 165 women, 117 (70.9%) returned for 6-12 week postpartum OGTT: 23 (19.6%) were abnormal. Smoking and parity, independent of socioeconomic status, were associated with non-return for testing. Fasting glucose ≥5.4 mmol/L on pregnancy OGTT predicted both non-return for testing and abnormal OGTT. During 5.5 years post-pregnancy, 148 (89.7%) women accessed glucose screening: nine (6.1%) developed diabetes, 33 (22.3%) had impaired fasting glucose / impaired glucose tolerance. Predictors of abnormal glucose tolerance were fasting glucose ≥5.4 mmol/L and 2-h glucose ≥9.3 mmol/L on pregnancy OGTT (2.5-fold increased risk), and polycystic ovary syndrome (3.4 fold increased risk). Risk score calculation, based on combined antenatal factors, did not improve predictions.
Antenatal clinical factors were modestly predictive of return for testing and abnormal glucose tolerance post-pregnancy in women with GDM. Risk score calculations were ineffective in predicting outcomes: risk scores developed in other populations require validation. Ongoing glucose screening is indicated for all women with GDM.
妊娠期糖尿病（GDM）与2型糖尿病的终生患病风险增加有关：建议患病女性在产后6 - 12周进行口服葡萄糖耐量试验（OGTT），然后每1 - 3年进行一次血糖筛查。
我们调查了在患有GDM的女性中，产前临床因素是否能预测产后葡萄糖耐量异常以及筛查的依从性。
回顾性收集了2007年至2009年年中在一家医院分娩的患有GDM的女性的产前/产科数据以及产后6 - 12周和妊娠后5.5年期间的血糖检测结果。使用多变量分析确定检测复诊和葡萄糖耐量异常的预测因素。
165名女性中，117名（70.9%）返回进行产后6 - 12周的OGTT：23名（19.6%）结果异常。吸烟和产次，独立于社会经济地位，与未返回检测有关。妊娠OGTT时空腹血糖≥5.4 mmol/L可预测未返回检测和OGTT异常。在妊娠后5.5年期间，148名（89.7%）女性进行了血糖筛查：9名（6.1%）患糖尿病，33名（22.3%）空腹血糖受损/葡萄糖耐量受损。葡萄糖耐量异常的预测因素为妊娠OGTT时空腹血糖≥5.4 mmol/L和2小时血糖≥9.3 mmol/L（风险增加约2.5倍），以及多囊卵巢综合征（风险增加约3.4倍）。基于综合产前因素的风险评分计算并不能改善预测效果。
产前临床因素对患有GDM的女性产后检测复诊和葡萄糖耐量异常有一定的预测作用。风险评分计算在预测结果方面无效：在其他人群中开发的风险评分需要验证。所有患有GDM的女性都需要持续进行血糖筛查。
