Nachtergaele Charlotte, Vicaut Eric, Tatulashvili Sopio, Pinto Sara, Bihan Hélène, Sal Meriem, Berkane Narimane, Allard Lucie, Baudry Camille, Portal Jean-Jacques, Carbillon Lionel, Cosson Emmanuel
AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, 75009 Paris, France.
AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93 000 Bobigny, France.
J Clin Med. 2021 Jan 21;10(3):397. doi: 10.3390/jcm10030397.
We aimed to evaluate each proposal of Australian-New Zealand Societies to limit the number of oral glucose tolerance tests (OGTTs) to diagnose hyperglycemia in pregnancy (HIP) during the coronavirus disease 2019 (COVID-19) pandemic. At our university hospital (2012-2016), we retrospectively applied in 4245 women who had OGTT between 22 and 30 weeks of gestation (reference standard: WHO criteria) the proposals in which OGTT is performed only in high-risk women; in all (Option 1) or high-risk (Option 1-Sel) women with fasting plasma glucose (FPG) 4.7-5.0 mmol/L; in all (Option 2) or high-risk (Option 2-Sel) women without history of HIP and with FPG 4.7-5.0 mmol/L. We also tested FPG measurement alone in all high-risk women. Measuring FPG alone had a sensitivity of 49% (95% confidence interval 45-54) applying universal screening. Option 2 appeared to have the best balance considering the needed OGTT (17.3%), sensitivity (72% (67-76)) and rates of a composite outcome (true negative cases: 10.6%, false positive cases: 24.4%; true positive cases: 19.5%; false negative cases: 10.2%). Consideration of a history of HIP and measuring first FPG can avoid more than 80% of OGTTs and identify women with the highest risk of adverse HIP-related events.
我们旨在评估澳大利亚和新西兰各学会提出的关于在2019年冠状病毒病（COVID-19）大流行期间限制口服葡萄糖耐量试验（OGTT）次数以诊断妊娠期高血糖（HIP）的各项提议。在我们的大学医院（2012 - 2016年），我们对4245名在妊娠22至30周期间进行了OGTT的女性（参考标准：世界卫生组织标准）进行了回顾性分析，应用了以下提议：仅对高危女性进行OGTT；对空腹血糖（FPG）为4.7 - 5.0 mmol/L的所有女性（方案1）或高危女性（方案1 - Sel）进行OGTT；对无HIP病史且FPG为4.7 - 5.0 mmol/L的所有女性（方案2）或高危女性（方案2 - Sel）进行OGTT。我们还对所有高危女性单独进行了FPG测量。在进行普遍筛查时，单独测量FPG的灵敏度为49%（95%置信区间45 - 54）。考虑到所需的OGTT次数（17.3%）、灵敏度（72%（67 - 76））以及复合结局的发生率（真阴性病例：10.6%，假阳性病例：24.4%；真阳性病例：19.5%；假阴性病例：10.2%），方案2似乎具有最佳的平衡。考虑HIP病史并首先测量FPG可以避免超过80%的OGTT，并识别出发生不良HIP相关事件风险最高的女性。
