Department of Medicine, Division of Endocrinology Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Department of Obstetrics & Gynaecology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
PLoS One. 2020 Oct 5;15(10):e0239720. doi: 10.1371/journal.pone.0239720. eCollection 2020.
Women with hyperglycaemia first detected in pregnancy (HFDP), including those with gestational diabetes mellitus (GDM), should undergo a glucose evaluation 4-12 weeks after delivery. Globally, suboptimal postpartum return rates limit the opportunity to intervene in women with sustained hyperglycaemia and pragmatic solutions should be sought to bridge this gap.
To assess the utility of postpartum in-hospital glucose evaluation to predict the outcome of the oral glucose tolerance test (OGTT) performed 4-12 weeks after delivery.
The study was performed prospectively at Tygerberg Hospital, Cape Town, South Africa. Women with HFDP, classified as GDM based on the modified National Institute for Health and Care Excellence criteria, who delivered between November 2018 and June 2019 were included in the study. Fasting plasma glucose (FPG) was performed 24-72 hours after delivery (t1) in the postnatal ward, provided glucose lowering medication was discontinued at delivery. An OGTT 4-12 weeks postpartum (t2) was scheduled for the total cohort. We compared glucose values and glucose categories at t1 and t2 and evaluated antenatal characteristics of women who returned, compared to the group that was lost to follow-up.
In-hospital post-delivery glucose assessment (t1) was performed in 115 women. Glucose levels were significantly lower at t1 compared to antenatal diagnostic values (t0) and assessment at t2. Of the fourteen women with hyperglycaemia at t2, none had abnormal fasting glucose concentrations at t1. Women with HFDP who fulfilled criteria for overt diabetes at t0, all (24/115) had normal fasting glucose levels at t1 except for IFG in one (1/24). The antenatal characteristics of women with HFDP who returned at t2, were similar to the women who did not return.
Based on this study, in-hospital fasting glucose 24-72 hours postpartum cannot replace the OGTT 4-12 weeks postpartum. Pragmatic solutions for low postpartum return rates in women with HFDP should be pursued.
在妊娠期间首次发现高血糖的女性（HFDP），包括患有妊娠糖尿病（GDM）的女性，应在分娩后 4-12 周进行葡萄糖评估。在全球范围内，产后返回率不理想限制了对持续高血糖女性进行干预的机会，因此应寻求切实可行的解决方案来弥补这一差距。
评估产后住院期间的血糖评估对预测分娩后 4-12 周进行口服葡萄糖耐量试验（OGTT）结果的作用。
该研究在南非开普敦泰格伯格医院进行，前瞻性研究。2018 年 11 月至 2019 年 6 月期间分娩的 HFDP 女性，基于改良的国家卫生与保健卓越研究所（National Institute for Health and Care Excellence）标准诊断为 GDM 的女性被纳入研究。分娩后 24-72 小时（t1）在产后病房进行空腹血糖（FPG）检查，前提是分娩时停止使用降血糖药物。所有患者都计划在产后 4-12 周进行 OGTT（t2）。我们比较了 t1 和 t2 时的血糖值和血糖类别，并评估了返回组和失访组的女性的产前特征。
115 名女性进行了产后住院期间的血糖评估（t1）。t1 时的血糖水平明显低于产前诊断值（t0）和 t2 时的血糖水平。在 t2 时血糖升高的 14 名女性中，无一例在 t1 时出现空腹血糖异常。在 t0 时符合显性糖尿病标准的 HFDP 女性中，除了 1 例 IFG 外，其余 24 例（115 例中的 24 例）t1 时空腹血糖水平正常。在 t2 时返回的 HFDP 女性的产前特征与未返回的女性相似。
基于这项研究，产后 24-72 小时的住院期间空腹血糖不能替代产后 4-12 周的 OGTT。应寻求切实可行的解决方案来提高 HFDP 女性的产后返回率。
