Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Am J Perinatol. 2024 Dec;41(16):2284-2289. doi: 10.1055/a-2312-8740. Epub 2024 Apr 24.
Rates of completion of the gold standard 2-hour oral glucose tolerance test (OGTT) for impaired glucose intolerance postpartum in patients with gestational diabetes mellitus (GDM) are consistently less than 50%. Screening tests performed prior to hospital discharge, including fasting blood glucose (FBG) to detect persistent hyperglycemia, have been investigated. We lack evidence, however, on whether implementation of routine postpartum FBG impacts the likelihood of obtaining the routine 2-hour OGTT. We sought to retrospectively compare the rates of completion of the 2-hour OGTT pre- and postimplementation of a routine FBG screen.
We performed a single-center retrospective cohort study comparing the completion of the 2-hour OGTT pre- and postimplementation of a routine FBG screen. Our primary outcome was the completion of the postpartum OGTT. Bivariate analyses assessed associations between demographic and preinduction clinical characteristics by pre- and post-implementation groups, as well as OGTT completion. Multivariable logistic regression was used to control for possible confounders. A sensitivity analysis was performed to account for the overlap with the coronavirus disease 2019pandemic.
In total, 468 patients met the inclusion and exclusion criteria. In our post-intervention group, 64% of patients completed a postpartum FBG. For our primary outcome, completion of the 2-hour OGTT significantly decreased in our postintervention group from 37.1 to 25.9% ( = 0.009), adjusted odds ratio (aOR): 0.62, confidence interval (CI): 0.41-0.92. This difference was no longer statistically significant when excluding patients during the pandemic, from 40.3 to 33.1% ( = 0.228), aOR: 0.76, CI: 0.455-1.27.
Implementation of a routine FBG was associated with a negative impact on patients completing a 2-hour OGTT. The difference was no longer significant when excluding patients who would have obtained the OGTT during the pandemic, which may have been due to the smaller cohort. Future work should investigate patient perceptions of the FBG and its impact on their decision-making around the OGTT.
· Screening for postpartum glucose intolerance is imperative for gestational diabetics.. · A fasting blood glucose is recommended as a postpartum screen for hyperglycemia in GDM patients.. · Implementation of an FBG was associated with a decrease in completion of the gold standard OGTT..
对于患有妊娠期糖尿病（GDM）的患者，完成金标准 2 小时口服葡萄糖耐量试验（OGTT）的比例始终低于 50%。已经研究了在出院前进行的筛查试验，包括空腹血糖（FBG）以检测持续性高血糖。然而，我们缺乏关于实施常规产后 FBG 是否会影响获得常规 2 小时 OGTT 的证据。我们试图回顾性比较实施常规 FBG 筛查前后 2 小时 OGTT 完成率。
我们进行了一项单中心回顾性队列研究，比较了实施常规 FBG 筛查前后 2 小时 OGTT 的完成情况。我们的主要结局是完成产后 OGTT。双变量分析评估了实施前后两组之间人口统计学和诱导前临床特征之间的关联，以及 OGTT 完成情况。多变量逻辑回归用于控制可能的混杂因素。进行了敏感性分析以考虑与 2019 年冠状病毒病（COVID-19）大流行的重叠。
共有 468 名患者符合纳入和排除标准。在我们的干预后组中，64%的患者完成了产后 FBG。对于我们的主要结局，干预后组中 2 小时 OGTT 的完成率从 37.1%显著下降至 25.9%（=0.009），调整后的优势比（aOR）：0.62，置信区间（CI）：0.41-0.92。当排除大流行期间的患者时，这种差异不再具有统计学意义，从 40.3%降至 33.1%（=0.228），aOR：0.76，CI：0.455-1.27。
实施常规 FBG 与患者完成 2 小时 OGTT 的比例下降有关。当排除大流行期间将接受 OGTT 的患者时，差异不再显著，这可能是由于队列规模较小。未来的工作应调查患者对 FBG 的看法及其对他们围绕 OGTT 做出决策的影响。
· 筛查产后葡萄糖耐量异常对于患有妊娠期糖尿病的患者至关重要。· 建议对 GDM 患者进行空腹血糖筛查以检测高血糖。· 实施 FBG 与完成金标准 OGTT 的比例下降有关。
