Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, IL.
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
Am J Obstet Gynecol. 2020 Jan;222(1):73.e1-73.e11. doi: 10.1016/j.ajog.2019.07.035. Epub 2019 Jul 24.
Less than one-half of women with gestational diabetes mellitus are screened for type 2 diabetes postpartum. Other approaches to postpartum screening need to be evaluated, including the role of screening during the delivery hospitalization.
To assess the performance of an oral glucose tolerance test administered during the delivery hospitalization compared with the oral glucose tolerance test administered at a 4- to 12-week postpartum visit.
We conducted a combined analysis of patient-level data from 4 centers (6 clinical sites) assessing the utility of an immediate postpartum 75-g oral glucose tolerance test during the delivery hospitalization (PP1) for the diagnosis of type 2 diabetes compared with a routine 4- to 12-week postpartum oral glucose tolerance test (PP2). Eligible women underwent a 75-g oral glucose tolerance test at both PP1 and PP2. Sensitivity, specificity, and negative and positive predictive values of the PP1 test were estimated for diagnosis of type 2 diabetes, impaired fasting glucose, or impaired glucose tolerance.
In total, 319 women completed a PP1 screening, with 152 (47.6%) lost to follow-up for the PP2 oral glucose tolerance test. None of the women with a normal PP1 oral glucose tolerance test (n=73) later tested as having type 2 diabetes at PP2. Overall, 12.6% of subjects (n=21) had a change from normal to impaired fasting glucose/impaired glucose tolerance or a change from impaired fasting glucose/impaired glucose tolerance to type 2 diabetes. The PP1 oral glucose tolerance test had 50% sensitivity (11.8-88.2), 95.7% specificity (91.3-98.2%) with a 98.1% (94.5-99.6%) negative predictive value and a 30% (95% confidence interval, 6.7-65.3) positive predictive value for type 2 diabetes vs normal/impaired fasting glucose/impaired glucose tolerance result. The negative predictive value of having type 2 diabetes at PP2 compared with a normal oral glucose tolerance test (excluding impaired fasting glucose/impaired glucose tolerance) at PP1 was 100% (95% confidence interval, 93.5-100) with a specificity of 96.5% (95% confidence interval, 87.9-99.6).
A normal oral glucose tolerance test during the delivery hospitalization appears to exclude postpartum type 2 diabetes mellitus. However, the results of the immediate postpartum oral glucose tolerance test were mixed when including impaired fasting glucose or impaired glucose tolerance. As a majority of women do not return for postpartum diabetic screening, an oral glucose tolerance test during the delivery hospitalization may be of use in certain circumstances in which postpartum follow-up is challenging and resources could be focused on women with an abnormal screening immediately after the delivery hospitalization.
不到一半的妊娠糖尿病女性在产后接受 2 型糖尿病筛查。需要评估其他产后筛查方法，包括分娩住院期间筛查的作用。
评估分娩住院期间进行口服葡萄糖耐量试验（75g）与产后 4-12 周进行口服葡萄糖耐量试验（75g）的效果。
我们对来自 4 个中心（6 个临床地点）的患者水平数据进行了综合分析，评估了分娩住院期间即刻进行产后 75g 口服葡萄糖耐量试验（PP1）用于诊断 2 型糖尿病的效用，与常规产后 4-12 周口服葡萄糖耐量试验（PP2）相比。符合条件的女性在 PP1 和 PP2 均接受 75g 口服葡萄糖耐量试验。估计了 PP1 试验用于诊断 2 型糖尿病、空腹血糖受损或糖耐量受损的敏感性、特异性、阴性和阳性预测值。
共有 319 名女性完成了 PP1 筛查，其中 152 名（47.6%）因未进行 PP2 口服葡萄糖耐量试验而失访。在 PP2 时，没有任何 PP1 口服葡萄糖耐量试验正常的女性（n=73）后来被诊断为 2 型糖尿病。总的来说，12.6%的受试者（n=21）从正常空腹血糖受损/糖耐量受损转变为 2 型糖尿病，或从空腹血糖受损/糖耐量受损转变为 2 型糖尿病。PP1 口服葡萄糖耐量试验对 2 型糖尿病的敏感性为 50%（11.8-88.2），特异性为 95.7%（91.3-98.2%），阴性预测值为 98.1%（94.5-99.6%），阳性预测值为 30%（95%置信区间为 6.7-65.3%）。PP2 时诊断为 2 型糖尿病的阴性预测值与 PP1 时正常/空腹血糖受损/糖耐量受损结果相比为 100%（95%置信区间为 93.5-100），特异性为 96.5%（95%置信区间为 87.9-99.6%）。
分娩住院期间的口服葡萄糖耐量试验正常似乎可排除产后 2 型糖尿病。然而，当包括空腹血糖受损或糖耐量受损时，即刻产后口服葡萄糖耐量试验的结果参差不齐。由于大多数女性未进行产后糖尿病筛查，因此在产后随访具有挑战性且资源可以集中在分娩后住院期间筛查异常的女性时，分娩住院期间进行口服葡萄糖耐量试验可能会有所帮助。
