Carter E B, Martin S, Temming L A, Colditz G A, Macones G A, Tuuli M G
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, St Louis, MO, USA.
J Perinatol. 2018 Feb;38(2):118-121. doi: 10.1038/jp.2017.159. Epub 2017 Oct 19.
The objective of this study is to estimate the accuracy of early oral glucose tolerance testing (GTT), to predict impaired glucose tolerance.
This was a prospective cohort study. Women received an early 75 g 2 h GTT between postpartum days 2-4 and again 6-12 weeks postpartum. The ability of the early GTT to accurately detect impaired glucose tolerance and diabetes was assessed by calculating sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPVs). The routine 6-12-week postpartum GTT was considered the gold standard.
The early GTT was completed by 100% of subjects, whereas only 31 of 58 (53%) women returned to complete the 6-12-week postpartum GTT. The early GTT had modest sensitivity for impaired glucose tolerance (62.5%) and overt diabetes (50%). However, it had excellent specificity (100%), PPV (100%) and NPV (96.7%) for diabetes. The NPV for impaired glucose tolerance with the early GTT was 80%.
Rates of 6-12 week postpartum GTT completion among patients with gestational diabetes is poor. Appropriate postpartum management may improve by using the early GTT as a screening test.
本研究的目的是评估早期口服葡萄糖耐量试验（GTT）预测糖耐量受损的准确性。
这是一项前瞻性队列研究。女性在产后第2至4天接受早期75克2小时GTT检查，并在产后6至12周再次接受检查。通过计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）来评估早期GTT准确检测糖耐量受损和糖尿病的能力。产后6至12周的常规GTT被视为金标准。
100%的受试者完成了早期GTT检查，而58名女性中只有31名（53%）返回完成产后6至12周的GTT检查。早期GTT对糖耐量受损的敏感性适中（62.5%），对显性糖尿病的敏感性为50%。然而，它对糖尿病具有出色的特异性（100%）、PPV（100%）和NPV（96.7%）。早期GTT对糖耐量受损的NPV为80%。
妊娠期糖尿病患者产后6至12周GTT检查的完成率较低。将早期GTT用作筛查试验可能会改善产后的适当管理。
