Abu Shqara Raneen, Or Shany, Wiener Yifat, Lowenstein Lior, Frank Wolf Maya
Department of Obstetrics & Gynecology, Galilee Medical Center, PO Box 21, 22100, Nahariya, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Arch Gynecol Obstet. 2023 Feb;307(2):421-429. doi: 10.1007/s00404-022-06520-5. Epub 2022 Mar 28.
The clinical implications of gestational diabetes mellitus (GDM) diagnosed in the third trimester are not well established and controversy continues regarding the performance of diagnostic tests beyond 28-week gestation. This study aimed to evaluate the incidence of abnormal third trimester oral glucose tolerance test (OGTT) results in women at high risk and to compare the obstetric and neonatal outcomes with those of women with normal OGTT results.
The study included 372 women who completed late (>29 weeks) 100-g OGTT due to suspected fetal macrosomia, polyhydramnios or a personal risk factor for GDM, diagnosed according to the Carpenter & Coustan criteria. Women with only one abnormal OGTT value were diagnosed with GDM by abnormal glucose follow-up and analyzed separately. Obstetric and neonatal outcomes were compared between the GDM and the non-GDM groups.
GDM was diagnosed in 85/372 (22%) women, including 35 (59.3%) women with one abnormal OGTT value who were later diagnosed with GDM. Of 200 women who had a normal 1-h 50-g glucose challenge test at 24-28 weeks, late GDM was diagnosed in 33 (16.5%). Seventy-six (89.5%) of those with GDM were treated by dietary therapy and 9 (10.5%) by pharmacological therapy. Among women with GDM, large-for-gestational-age fetuses, labor induction and elective cesarean section were more prevalent than for those without GDM. Significant differences were not found between the groups in macrosomia and neonatal outcomes.
The performance of OGTT in women with risk factors during the third trimester should be considered following further prospective trials.
妊娠晚期诊断的妊娠期糖尿病（GDM）的临床意义尚未完全明确，关于妊娠28周后诊断试验的应用仍存在争议。本研究旨在评估高危女性妊娠晚期口服葡萄糖耐量试验（OGTT）结果异常的发生率，并比较OGTT结果正常的女性与异常女性的产科和新生儿结局。
本研究纳入372名因怀疑胎儿巨大、羊水过多或有GDM个人风险因素而在孕晚期（>29周）完成100g OGTT的女性，根据Carpenter & Coustan标准进行诊断。仅一项OGTT值异常的女性通过血糖随访诊断为GDM并单独分析。比较GDM组和非GDM组的产科和新生儿结局。
85/372（22%）名女性被诊断为GDM，其中35名（59.3%）OGTT值异常的女性随后被诊断为GDM。在24 - 28周50g葡萄糖筛查试验1小时结果正常的200名女性中，33名（16.5%）被诊断为晚期GDM。76名（89.5%）GDM患者接受饮食治疗，9名（10.5%）接受药物治疗。GDM女性中，大于胎龄儿、引产和择期剖宫产的发生率高于非GDM女性。两组在巨大儿和新生儿结局方面未发现显著差异。
在进一步的前瞻性试验之后，应考虑对孕晚期有风险因素的女性进行OGTT检查。
