Research Centre of the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada.
Endocrine Division, Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Can J Diabetes. 2019 Dec;43(8):627-635. doi: 10.1016/j.jcjd.2019.02.004. Epub 2019 Feb 18.
To compare: 1) 75 g oral glucose tolerance test (OGTT) and self-monitoring of blood glucose (SMBG) in identifying gestational diabetes mellitus (GDM) and other hyperglycemic statuses in pregnant women; 2) pregnancy outcomes according to glycemic status; and 3) participants' opinions regarding both methods.
A prospective study in women with a 50 g glucose load test ≥7.2 mmol/L at 24 to 28 weeks' gestation and singleton pregnancy. Women underwent OGTT (blinded) at day 1, followed by 7 days of SMBG (4 daily measurements: fasting and 2 h postprandially) without modifying diet or lifestyle. GDM (OGTT+) was diagnosed using the criteria of the International Association of the Diabetes and Pregnancy Study Groups, while pregnancy hyperglycemia (SMBG+) was defined as ≥4/7 glucose values ≥5.3 after fasting or ≥6.7 mmol/L 2 h postprandially for any meal of the day. Equivalent management was provided to women with GDM and/or pregnancy-related hyperglycemia.
We divided 103 participants (age: 29.5±5.0 years; prepregnancy body mass index: 25.3±5.4 kg/m) into 4 groups according to test results: OGTT+/SMBG+ (n=12, 11.7%); OGTT+/SMBG- (n=14, 13.6%); OGTT-/SMBG+ (n=9, 8.7%); and OGTT-/SMBG- (n=68, 66.0%). Clinical characteristics and maternal outcomes were statistically similar between groups. Neonatal complication rates were greater in groups with hyperglycemia than in the OGTT-/SMBG- group, notably neonatal hypoglycemia (9/12, 7/14, 5/9 vs. 6/68; p<0.001). Participants reported no convenience difference between methods but would prefer OGTT for a future pregnancy.
More than half of the women with OGTT+ were normoglycemic in daily life. Conversely, 11.7% of women with OGTT- had pregnancy hyperglycemia. OGTT+ and/or SMBG+ were equally associated with greater neonatal complications. This study suggests that alongside OGTT, SMBG could improve the care of pregnant women.
比较 1）75g 口服葡萄糖耐量试验（OGTT）和自我血糖监测（SMBG）在识别孕妇妊娠期糖尿病（GDM）和其他高血糖状态中的作用；2）根据血糖状态的妊娠结局；3）参与者对两种方法的看法。
对 24 至 28 周妊娠时 50g 葡萄糖负荷试验≥7.2mmol/L且单胎妊娠的妇女进行前瞻性研究。妇女在第 1 天进行 OGTT（盲法），然后进行 7 天 SMBG（4 次日常测量：空腹和餐后 2 小时），不改变饮食或生活方式。GDM（OGTT+）采用国际糖尿病与妊娠研究协会的标准诊断，而妊娠高血糖（SMBG+）定义为任何一餐空腹后≥4/7 血糖值≥5.3mmol/L 或餐后 2 小时≥6.7mmol/L。对 GDM 和/或与妊娠相关的高血糖妇女给予等效管理。
我们根据检测结果将 103 名参与者（年龄：29.5±5.0 岁；孕前体重指数：25.3±5.4kg/m²）分为 4 组：OGTT+/SMBG+（n=12，11.7%）；OGTT+/SMBG-（n=14，13.6%）；OGTT-/SMBG+（n=9，8.7%）；OGTT-/SMBG-（n=68，66.0%）。各组间临床特征和母婴结局无统计学差异。高血糖组新生儿并发症发生率高于 OGTT-/SMBG-组，尤其是新生儿低血糖（9/12、7/14、5/9 与 6/68；p<0.001）。参与者报告两种方法在便利性方面无差异，但希望在未来妊娠时采用 OGTT。
OGTT+的女性中超过一半在日常生活中血糖正常。相反，OGTT-的女性中有 11.7%发生妊娠高血糖。OGTT+和/或 SMBG+与更大的新生儿并发症发生率相关。本研究表明，除 OGTT 外，SMBG 还可改善孕妇的护理。
