Kuo Chun-Heng, Chen Szu-Chi, Fang Chi-Tai, Nien Feng-Jung, Wu En-Tzu, Lin Shin-Yu, Chuang Lee-Ming, Lee Chien-Nan, Li Hung-Yuan
Department of Internal Medicine, New Taipei City Hospital, New Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
PLoS One. 2017 Mar 15;12(3):e0173049. doi: 10.1371/journal.pone.0173049. eCollection 2017.
Using a specific cutoff of fasting plasma glucose (FPG) to screen gestational diabetes mellitus (GDM) can reduce the use of oral glucose tolerance tests (OGTT). Since the prevalence of GDM increases with age, this screening method may not be appropriate in healthcare systems where women become pregnant at older ages. Therefore, we aimed to develop a screening algorithm for GDM that takes maternal age into consideration.
We included 945 pregnant women without history of GDM who received 75g OGTT to diagnose GDM in 2011. Screening algorithms using FPG with or without age were developed. Another 362 pregnant women were recruited in 2013-2015 as the validation cohort.
Using FPG criteria alone, more GDM diagnoses were missed in women ≥35 years than in women <35 years (13.2% vs. 5.8%, p <0.001). Among GDM women ≥35 years, 63.6% had FPG <92 mg/dL (5.1 mmol/L). Use of the algorithm with an "age plus FPG" cutoff could reduce the use of OGTT (OGTT%) from 77.6% to 62.9%, while maintaining good sensitivity (from 91.9% to 90.2%) and specificity (from 100% to 100%). Similar reduction in OGTT% was found in the validation cohort (from 86.4% to 76.8%). In the simulation, if the percentage of women ≥35 years were 40% or more, the screening algorithm with an "age plus FPG" cutoff could further reduce OGTT% by 11.0%-18.8%.
A screening algorithm for GDM that takes maternal age into consideration can reduce the use of OGTT when women become pregnant at older ages.
采用特定的空腹血糖（FPG）临界值筛查妊娠期糖尿病（GDM）可减少口服葡萄糖耐量试验（OGTT）的使用。由于GDM的患病率随年龄增长而增加，这种筛查方法在女性高龄怀孕的医疗系统中可能并不适用。因此，我们旨在开发一种将孕妇年龄考虑在内的GDM筛查算法。
我们纳入了945名无GDM病史的孕妇，她们在2011年接受了75g OGTT以诊断GDM。开发了使用FPG且考虑或不考虑年龄的筛查算法。2013 - 2015年又招募了362名孕妇作为验证队列。
仅使用FPG标准时，35岁及以上女性漏诊的GDM病例比35岁以下女性更多（13.2%对5.8%，p<0.001）。在35岁及以上的GDM女性中，63.6%的FPG<92mg/dL（5.1mmol/L）。使用“年龄加FPG”临界值的算法可将OGTT的使用比例（OGTT%）从77.6%降至62.9%，同时保持良好的敏感性（从91.9%降至90.2%）和特异性（从100%降至100%）。在验证队列中也发现了类似的OGTT%降低情况（从86.4%降至76.8%）。模拟结果显示，如果35岁及以上女性的比例为40%或更高，采用“年龄加FPG”临界值的筛查算法可使OGTT%进一步降低11.0% - 18.8%。
一种将孕妇年龄考虑在内的GDM筛查算法，在女性高龄怀孕时可减少OGTT的使用。
