Wilkie Gianna L, Delpapa Ellen, Leftwich Heidi K
Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Massachusetts Memorial HealthCare and University of Massachusetts Medical School, Worcester, MA, USA.
J Obstet Gynaecol. 2022 Nov;42(8):3498-3502. doi: 10.1080/01443615.2022.2151344. Epub 2022 Nov 30.
This study sought to compare test characteristics of hemoglobin A1c, oral glucose tolerance test and fasting plasma glucose for the development of gestational diabetes among women with prediabetes. Diabetes outcomes were compared by screening test used for prediabetes diagnosis among a retrospective cohort of pregnant patients between 2017-2021. During the study, 8132 patients received diabetes screening and 14.0% met criteria for prediabetes. By screening test, 75.1% were screened with hemoglobin A1c, 10.0% with fasting plasma glucose and 14.9% with a 75-g oral glucose tolerance test. Hemoglobin A1c had the highest positive predictive value (67.2%). Use of hemoglobin A1c was significantly more likely to identify women with GDM than oral glucose tolerance test (aOR 3.94, 95% CI 2.30-6.73). In this study cohort, hemoglobin A1c was able to identify patients that were more likely to develop GDM in an at-risk population.IMPACT STATEMENT Prediabetes is becoming more common in the general population; however little is known about prediabetes in pregnancy. Women with prediabetes in pregnancy appear to be at increased risk of developing gestational diabetes mellitus, however there is minimal information about various screening tests performance in pregnancy for detection of prediabetes and subsequent gestational diabetes. The results of this study compare three commonly used screening tests for screening for diabetes. When identifying women with prediabetes, they are at increased risk for developing gestational diabetes mellitus if identified by hemoglobin A1c. The clinical implication of this study is that women can be screened with hemoglobin A1c in early pregnancy for both overt diabetes, but also may be identified as high risk with prediabetes. Among women with prediabetes by hemoglobin A1c, they remain at high risk for developing gestational diabetes mellitus.
本研究旨在比较糖化血红蛋白、口服葡萄糖耐量试验和空腹血糖在糖尿病前期女性中用于诊断妊娠期糖尿病的检测特征。在一项2017 - 2021年间怀孕患者的回顾性队列研究中，根据用于糖尿病前期诊断的筛查试验对糖尿病结局进行了比较。研究期间，8132名患者接受了糖尿病筛查，14.0%符合糖尿病前期标准。通过筛查试验，75.1%的患者采用糖化血红蛋白进行筛查，10.0%采用空腹血糖，14.9%采用75克口服葡萄糖耐量试验。糖化血红蛋白具有最高的阳性预测值（67.2%）。与口服葡萄糖耐量试验相比，使用糖化血红蛋白显著更有可能识别出患有妊娠期糖尿病的女性（调整后比值比3.94，95%置信区间2.30 - 6.73）。在本研究队列中，糖化血红蛋白能够识别出高危人群中更有可能患妊娠期糖尿病的患者。影响声明糖尿病前期在普通人群中越来越普遍；然而，关于妊娠期糖尿病前期却知之甚少。妊娠期糖尿病前期的女性似乎患妊娠期糖尿病的风险增加，然而，关于孕期各种筛查试验在检测糖尿病前期及后续妊娠期糖尿病方面的表现，相关信息极少。本研究结果比较了三种常用的糖尿病筛查试验。在识别糖尿病前期女性时，如果通过糖化血红蛋白识别出来，她们患妊娠期糖尿病的风险会增加。本研究的临床意义在于，女性在孕早期可用糖化血红蛋白进行筛查，不仅用于显性糖尿病，还可识别出糖尿病前期的高危人群。在通过糖化血红蛋白诊断为糖尿病前期的女性中，她们患妊娠期糖尿病的风险仍然很高。
