Hughes Ruth C E, Florkowski Chris, Gullam Joanna E
Department of Obstetrics and Gynaecology, University of Otago, Christchurch, New Zealand.
Canterbury Health Laboratories and Christchurch Diabetes centre, Christchurch, New Zealand.
Aust N Z J Obstet Gynaecol. 2018 Aug;58(4):432-437. doi: 10.1111/ajo.12746. Epub 2017 Nov 17.
Recent New Zealand guidelines recommend annual glycated haemoglobin (HbA1c) measurements from three months postpartum, replacing the glucose tolerance test (GTT) at six weeks, to screen for persistent hyperglycaemia following gestational diabetes. Data suggest that this screening approach may miss cases of type 2 diabetes, but are they detected at subsequent screening and will screening rates improve?
Our aim was to evaluate the effectiveness of HbA1c monitoring in improving screening rates following gestational diabetes and in detecting postpartum hyperglycaemia.
During 2015 in Christchurch, all women with gestational diabetes were offered HbA1c and GTT measurements at three months postpartum and subsequent annual HbA1c measurements were recommended. Data from electronic hospital records were collected for a minimum 18 months postpartum.
Of the cohort of 333 women, 218 (65%) completed both HbA1c and GTT at three months postpartum, 74 (22%) HbA1c only, 16 (5%) GTT only, 25 (8%) no screening; 184 (55%) had subsequent HbA1c tests. Diabetes was detected by GTT in five (2%) women and by HbA1c in only one out of five (20%); the disagreement between tests resolved in three out of four (75%) women with subsequent testing. Prediabetes was detected by GTT in 30 (14%) women; however, HbA1c only detected five out of 30 (17%) and subsequent HbA1c testing identified a further two out of 30 with prediabetes.
HbA1c measurement at three months postpartum had a good uptake. However, most cases of diabetes were identified by subsequent HbA1c testing, the uptake of which was suboptimal. The importance of annual HbA1c monitoring following gestational diabetes needs greater emphasis.
新西兰近期指南建议，产后三个月起每年测量糖化血红蛋白（HbA1c），取代六周时的葡萄糖耐量试验（GTT），以筛查妊娠糖尿病后的持续性高血糖。数据表明，这种筛查方法可能会漏诊2型糖尿病病例，但这些病例会在后续筛查中被发现吗？筛查率会提高吗？
我们的目的是评估HbA1c监测在提高妊娠糖尿病后筛查率及检测产后高血糖方面的有效性。
2015年在克赖斯特彻奇，所有妊娠糖尿病女性在产后三个月时均接受了HbA1c和GTT测量，并建议随后每年进行HbA1c测量。收集了产后至少18个月的电子医院记录数据。
在333名女性队列中，218名（65%）在产后三个月完成了HbA1c和GTT测量，74名（22%）仅完成了HbA1c测量，16名（5%）仅完成了GTT测量，25名（8%）未进行筛查；184名（55%）进行了后续HbA1c检测。通过GTT检测出5名（2%）女性患有糖尿病，通过HbA1c仅检测出5名中的1名（20%）；在后续检测的4名女性中，有3名（75%）检测结果的差异得到解决。通过GTT检测出30名（14%）女性患有糖尿病前期；然而，HbA1c仅检测出30名中的5名（17%），后续HbA1c检测又在30名中发现了另外2名患有糖尿病前期。
产后三个月测量HbA1c的接受度良好。然而，大多数糖尿病病例是通过后续HbA1c检测发现的，其接受度并不理想。需要更加强调妊娠糖尿病后每年进行HbA1c监测的重要性。
