Department of Obstetrics, The First School of Clinical Medicine, Shenzhen Maternity & Child Healthcare HospitalSouthern Medical UniversityFutian District, Hongli Road, Shenzhen, Guangdong Province, China.
BMC Pregnancy Childbirth. 2022 Jul 4;22(1):540. doi: 10.1186/s12884-022-04874-x.
Our previous studies have suggested that the first trimester fasting plasma glucose (FPG) level is associated with gestational diabetes mellitus (GDM) and is a predictor of GDM. The aim of the present study was to provide valuable insights into the accuracy of the first trimester FPG level in the screening and diagnosis of GDM in southern China.
This retrospective study included pregnant women who had their first trimester FPG level recorded at 9-13 weeks and underwent screening for GDM using the 2-h 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational weeks. Differences between the GDM and non-GDM groups were assessed by Student's t test and the chi-squared test according to the nature of the variables. A restricted cubic spine was used to explore the relationship between the first trimester FPG level and the odds ratio (OR) of GDM in pregnant women. Cut-off values of first trimester FPG were determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and 95% confidence intervals (CIs), the positive predictive value (PPV) and the negative predictive value (NPV) were calculated.
The medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The average first trimester FPG level was 4.62 ± 0.37 mmol/L. The OR of GDM increased with increasing first trimester FPG levels and with a value of first trimester FPG of approximately 4.6 mmol/L, which was equal to 1 (Chi-Square = 665.79, P < 0.001), and then started to increase rapidly afterwards. The ROC curve for fasting plasma glucose in the first trimester (4.735 mmol/L) for predicting gestational diabetes mellitus in pregnant women was 0.608 (95% CI: 0.598-0.617), with a sensitivity of 0.490 and a specificity of 0.676.
Based on the research, we recommend that all pregnant women undergo FPG testing in the first trimester, particularly at the first antenatal visit. Furthermore, we suggest that the risks of GDM should be given increased attention and management as soon as the first trimester FPG value is more than 4.7 mmol/L. First trimester FPG levels should be considered a screening marker when diagnosing GDM in pregnant women but this needs to be confirmed by more prospective studies. These factors may have a significant impact on the clinical treatment of pregnant women.
我们之前的研究表明，孕早期空腹血糖（FPG）水平与妊娠期糖尿病（GDM）有关，是 GDM 的预测指标。本研究旨在为中国南方地区孕早期 FPG 水平在 GDM 筛查和诊断中的准确性提供有价值的见解。
本回顾性研究纳入了在孕 9-13 周记录了孕早期 FPG 水平，并在 24-28 孕周期间进行了 2 小时 75g 口服葡萄糖耐量试验（OGTT）筛查的孕妇。根据变量的性质，采用 Student's t 检验和卡方检验评估 GDM 组和非 GDM 组之间的差异。采用受限立方样条探索孕早期 FPG 水平与 GDM 孕妇比值比（OR）之间的关系。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）确定孕早期 FPG 的截断值，并计算阳性预测值（PPV）和阴性预测值（NPV）。
分析了 28030 名孕妇的病历，其中 4669 名（16.66%）被诊断为 GDM。平均孕早期 FPG 水平为 4.62±0.37mmol/L。GDM 的 OR 随着孕早期 FPG 水平的升高而增加，当孕早期 FPG 水平约为 4.6mmol/L 时，OR 等于 1（卡方=665.79，P<0.001），之后迅速升高。用于预测孕妇妊娠期糖尿病的孕早期空腹血糖的 ROC 曲线（4.735mmol/L）为 0.608（95%CI：0.598-0.617），灵敏度为 0.490，特异性为 0.676。
基于本研究，我们建议所有孕妇在孕早期进行 FPG 检测，特别是在首次产前检查时。此外，我们建议一旦孕早期 FPG 值超过 4.7mmol/L，就应增加对 GDM 风险的关注和管理。孕早期 FPG 水平可作为孕妇 GDM 诊断的筛查指标，但这需要更多前瞻性研究来证实。这些因素可能对孕妇的临床治疗有重大影响。
