Örebro University hospital, Örebro University, Örebro, Sweden.
Department of Women's and Children's health, Uppsala University, Uppsala, Sweden.
BMC Pregnancy Childbirth. 2018 Jun 13;18(1):225. doi: 10.1186/s12884-018-1875-1.
The Swedish National Board of Health and Welfare (SNBHW) recommended the new diagnostic criteria for GDM based upon Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study thresholds. Due to limited knowledge base, no recommendations were made on GDM screening. The aim of this study is to evaluate test characteristics of risk factors and fasting blood glucose as screening tests for diagnosing GDM using diagnostic thresholds based upon HAPO study 1.75/2.0 (model I/II respectively) odds ratio for adverse pregnancy outcomes.
This cross-sectional, population-based study included all pregnant women who attended maternal health care in Örebro County, Sweden between the years 1994-96. A 75 g OGTT with capillary fasting and 2-h blood glucose was offered to all pregnant women at week 28-32. Risk factors and repeated random glucose samples were collected. Sensitivity, specificity and predictive values of blood glucose were calculated.
Prevalence of GDM was 11.7% with model I and 7.2% with the model II criteria. Risk factors showed 28%, (95% CI 24-32) and 31%, (95% CI 25-37) sensitivity for model I and II respectively. A fasting cut off ≥4.8 mmol/l occurred in 24% of women with 91%, (95% CI 88-94) sensitivity and 85%, (95% CI 83-86) specificity using model I while a fasting cut off ≥5.0 mmol/l occurred in 14% with 91%, (95% CI 87-94) sensitivity and 92%, (95% CI 91-93) specificity using model II.
Risk factor screening for GDM was found to be poorly predictive of GDM but fasting glucose of 4.8-5.0 mmol/l showed good test characteristics irrespective of diagnostic model and results in a low rate of OGTTs.
瑞典国家卫生和福利委员会（SNBHW）根据高血糖和不良妊娠结局（HAPO）研究阈值推荐了新的 GDM 诊断标准。由于知识基础有限，对于 GDM 筛查没有提出建议。本研究的目的是评估风险因素和空腹血糖作为筛查试验的检测特性，以诊断基于 HAPO 研究 1.75/2.0（分别为模型 I/II）比值的不良妊娠结局的 GDM。
这是一项横断面、基于人群的研究，纳入了 1994-96 年期间在瑞典厄勒布鲁县接受母婴保健的所有孕妇。所有孕妇在 28-32 周时均接受 75g OGTT 检测毛细血管空腹和 2 小时血糖。收集了风险因素和重复随机血糖样本。计算了血糖的敏感性、特异性和预测值。
GDM 的患病率为 11.7%，模型 I 为 7.2%。风险因素对模型 I 和 II 的敏感性分别为 28%（95%CI 24-32）和 31%（95%CI 25-37）。空腹血糖≥4.8mmol/l 的发生率为 24%，模型 I 的敏感性为 91%（95%CI 88-94），特异性为 85%（95%CI 83-86）；而空腹血糖≥5.0mmol/l 的发生率为 14%，模型 II 的敏感性为 91%（95%CI 87-94），特异性为 92%（95%CI 91-93）。
GDM 的风险因素筛查对 GDM 的预测性较差，但空腹血糖 4.8-5.0mmol/l 具有良好的检测特性，无论诊断模型和结果如何，OGTT 的发生率都较低。
