Sfameni Salvatore F, Wein Peter, Ngu Andrew C C
Department of Obstetrics and Gynaecology, The Northern Hospital, Melbourne, Victoria, Australia.
Department of Obstetrics, Freemason's Hospital, Melbourne, Victoria, Australia.
Int J Gynaecol Obstet. 2022 Sep;158(3):592-596. doi: 10.1002/ijgo.14043. Epub 2021 Dec 11.
To determine the cut-off value for the 75-g glucose challenge test administered in early pregnancy to screen for gestational diabetes mellitus and abnormal carbohydrate metabolism in pregnancy.
A prospective study involving 1500 antenatal patients attending a community hospital. Patients were screened with the 75-g 1-h glucose challenge test in early pregnancy and subsequently tested with the 75-g 2-h glucose tolerance test to diagnose gestational diabetes mellitus. Statistical methods were employed to determine the optimal plasma glucose cut-off value for a positive result in early pregnancy.
A glucose challenge test value of 6.0 mmol/L (108 mg/dl) or more was selected as the preferred cut-off level for further testing with a sensitivity of 83.5% (95% confidence interval [CI] 77.0%-88.9%) and specificity of 49.2% (95% CI 46.5%-52.0%).
An early pregnancy glucose challenge test reading of 6.0 mmol/L (108 mg/dl) or more is effective in screening for gestational diabetes mellitus; a value of 10.0 mmol/L (180 mg/dl) or more is effective for finding pre-pregnancy abnormalities of carbohydrate metabolism. The false-positive glucose challenge test diagnoses gestational hyperglycemia, the treatment of which will improve perinatal outcome. Further testing based on risk factors will exclude a false-negative glucose challenge test. A combination of universal early pregnancy screening and selective risk-factor testing is recommended to detect the full range of abnormalities of carbohydrate metabolism encountered in pregnancy.
确定孕早期75克葡萄糖耐量试验的临界值，以筛查妊娠期糖尿病和孕期碳水化合物代谢异常情况。
一项前瞻性研究，纳入了1500名在社区医院就诊的产前患者。患者在孕早期接受75克1小时葡萄糖耐量试验筛查，随后进行75克2小时葡萄糖耐量试验以诊断妊娠期糖尿病。采用统计学方法确定孕早期阳性结果的最佳血糖临界值。
选择6.0毫摩尔/升（108毫克/分升）或更高的葡萄糖耐量试验值作为进一步检测的首选临界水平，其灵敏度为83.5%（95%置信区间[CI] 77.0%-88.9%），特异性为49.2%（95%CI 46.5%-52.0%）。
孕早期葡萄糖耐量试验读数为6.0毫摩尔/升（108毫克/分升）或更高对筛查妊娠期糖尿病有效；10.0毫摩尔/升（180毫克/分升）或更高的值对发现孕前碳水化合物代谢异常有效。葡萄糖耐量试验假阳性诊断为妊娠期高血糖，对此进行治疗可改善围产期结局。基于风险因素的进一步检测将排除葡萄糖耐量试验假阴性。建议采用普遍的孕早期筛查和选择性风险因素检测相结合的方法，以检测孕期出现的各种碳水化合物代谢异常情况。
