University of Calgary, Department of Medicine, Division of Endocrinology and Metabolism, Calgary, Alberta, Canada; University of Calgary, Department of Obstetrics and Gynecology, Calgary, Alberta, Canada.
University of Calgary, Department of Medicine, Division of Endocrinology and Metabolism, Calgary, Alberta, Canada.
Can J Diabetes. 2017 Dec;41(6):596-602. doi: 10.1016/j.jcjd.2016.12.010. Epub 2017 Apr 25.
To examine outcomes associated with alternative glucose thresholds in a 2-step approach for screening and diagnosing gestational diabetes mellitus (GDM).
We studied 178,527 pregnancies between 2008 and 2012 in Alberta, Canada. They were categorized retrospectively as normal 50 g screen (n=144,191); normal 75 g oral glucose tolerance test (OGTT) (n=21,248); abnormal at glucose thresholds suggested by the International Association of Diabetes and Pregnancy Group (IADPSG) (HAPO 1.75, n=4308); abnormal at glucose thresholds associated with an odds ratio of 2.0 for adverse events in the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study. This latter group, which would have been treated for GDM based on customary care, was further divided into those with 1 (HAPO 2-1 n=5528) or 2 or more abnormal glucose values (HAPO 2-2 n=3252). Main outcomes were large for gestational age (LGA), induced labour and Cesarean-section rates.
LGA rates were 8.2%, 10.5%, 14.2%, 11.8% and 16.5% among normal 50 g, normal 75 g OGTT, HAPO 1.75, HAPO 2-1, and HAPO 2-2 groups, respectively. Labour induction and caesarean-section rates were 29.6% and 36.2% in the IADPSG, 38.2% and 36.8% in the HAPO 2-1 group, and 42.3% and 41.1% in the HAPO 2-2 groups, respectively. Excessive maternal weight (≥91 kg) was associated with a higher risk for all adverse outcomes.
The 2-step approach effectively identifies pregnancies at low risk for adverse outcomes. Labelling influences induction practice. Any glucose intolerance increases risk for adverse outcomes, and pregnancies with highest (2 or higher) abnormal glucose values remain at greatest risk. Further research is needed to determine whether glycemic thresholds for GDM diagnosis should incorporate information about maternal weight.
探讨两步法筛查和诊断妊娠期糖尿病（GDM）时采用不同血糖阈值的结局。
我们对加拿大艾伯塔省 2008 年至 2012 年间的 178527 例妊娠进行了回顾性研究。根据 50g 口服葡萄糖耐量试验（OGTT）结果将其分为正常组（n=144191）、正常 75g OGTT 组（n=21248）、国际妊娠合并糖尿病研究组织（IADPSG）建议的血糖阈值异常组（HAPO 1.75mmol/L，n=4308）、与 Hyperglycemia and Adverse Pregnancy Outcomes（HAPO）研究中不良事件比值比为 2.0 相关的血糖阈值异常组（HAPO 2-1mmol/L，n=5528；HAPO 2-2mmol/L，n=3252）。后一组将根据常规治疗诊断为 GDM，进一步分为 HAPO 2-1 组（n=5528，1 个或更多血糖值异常）和 HAPO 2-2 组（n=3252，2 个或更多血糖值异常）。主要结局为巨大儿（LGA）、引产和剖宫产率。
正常 50g、正常 75g OGTT、HAPO 1.75、HAPO 2-1 和 HAPO 2-2 组的 LGA 发生率分别为 8.2%、10.5%、14.2%、11.8%和 16.5%。IADPSG 组的引产率和剖宫产率分别为 29.6%和 36.2%，HAPO 2-1 组分别为 38.2%和 36.8%，HAPO 2-2 组分别为 42.3%和 41.1%。超重（≥91kg）与所有不良结局风险增加相关。
两步法可有效识别不良结局风险低的妊娠。标签会影响引产实践。任何糖耐量异常都会增加不良结局风险，血糖值异常最高（2 个或更多）的妊娠风险最大。需要进一步研究确定 GDM 诊断的血糖阈值是否应纳入母体体重信息。
