Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
J Matern Fetal Neonatal Med. 2022 Nov;35(21):4123-4129. doi: 10.1080/14767058.2020.1847073. Epub 2020 Nov 12.
The prevalence of preexisting type 2 diabetes mellitus (T2DM) in the United States is on the rise. Women of advanced maternal age (AMA, ≥35 years) are more likely to have preexisting T2DM in pregnancy because glucose intolerance increases with age. Diabetes in pregnancy is associated with significant maternal and neonatal morbidity and mortality, and earlier treatment initiation improves pregnancy outcomes. However, maternal age is not currently recognized as an independent risk factor that warrants diabetes screening prior to the traditional screen at 24-28 weeks gestation.
To evaluate the cost-effectiveness of screening all AMA women with a first trimester fasting plasma glucose (FPG) test for earlier diagnosis and management of preexisting T2DM.
A decision-analytic model was created to compare pregnancy outcomes in AMA women who undergo a first trimester FPG test vs third trimester oral glucose tolerance test alone. Probabilities were obtained from the literature. Outcomes examined included preeclampsia, preterm delivery, macrosomia, shoulder dystocia, brachial plexus injury (BPI), intrauterine fetal demise (IUFD), cerebral palsy, and neonatal death. The cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio of the first trimester screening strategy were examined as well. Sensitivity analyses and a Monte Carlo simulation were performed to test the model's robustness.
In AMA women, screening for preexisting T2DM in the first trimester with an FPG test resulted in fewer cases of preeclampsia, preterm delivery, BPI, IUFD, cerebral palsy, and neonatal death compared to performing a third trimester oral glucose tolerance test alone, and is cost-effective. Monte Carlo analysis incorporating the distribution of all probabilities showed that first trimester FPG screening remained cost-effective as long as the incremental cost of initiating diabetes treatment in the first trimester was less than $150,000 and the cost of the FPG screen was less than $2700.
Compared to third trimester oral glucose tolerance test alone, performing a first trimester FPG screen in AMA women is cost-saving and more effective.
美国 2 型糖尿病（T2DM）的患病率呈上升趋势。高龄产妇（AMA，≥35 岁）在怀孕期间更有可能患有 T2DM，因为随着年龄的增长，葡萄糖耐量会降低。妊娠糖尿病与产妇和新生儿发病率和死亡率显著相关，早期开始治疗可改善妊娠结局。然而，目前年龄并不是一个独立的危险因素，不需要在传统的 24-28 周妊娠时进行糖尿病筛查。
评估对所有 AMA 妇女进行孕早期空腹血糖（FPG）筛查，以更早诊断和管理 T2DM 的成本效益。
创建了一个决策分析模型，比较 AMA 妇女进行孕早期 FPG 筛查与单独进行孕晚期口服葡萄糖耐量试验的妊娠结局。概率来自文献。检查的结果包括子痫前期、早产、巨大儿、肩难产、臂丛神经损伤（BPI）、胎儿宫内死亡（IUFD）、脑瘫和新生儿死亡。还检查了孕早期筛查策略的成本、质量调整生命年（QALYs）和增量成本效益比。进行了敏感性分析和蒙特卡罗模拟以测试模型的稳健性。
在 AMA 妇女中，与单独进行孕晚期口服葡萄糖耐量试验相比，孕早期进行 FPG 筛查可减少子痫前期、早产、BPI、IUFD、脑瘫和新生儿死亡的病例，且具有成本效益。包含所有概率分布的蒙特卡罗分析表明，只要在孕早期开始治疗糖尿病的增量成本低于 15 万美元，且 FPG 筛查的成本低于 2700 美元，孕早期 FPG 筛查仍然具有成本效益。
与单独进行孕晚期口服葡萄糖耐量试验相比，在 AMA 妇女中进行孕早期 FPG 筛查具有成本效益且更有效。
