Ultrasound Unit, The Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel.
Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Ultrasound Obstet Gynecol. 2024 Sep;64(3):348-353. doi: 10.1002/uog.27719. Epub 2024 Aug 1.
To assess the capacity of fetal pancreatic size, before standard blood glucose testing for screening and diagnosis, to predict maternal gestational diabetes mellitus (GDM).
This was a retrospective cohort study of low-risk pregnant women recruited during routine second-trimester fetal anatomical screening at 20-25 weeks' gestation at two ultrasound units in Israel between 2017 and 2020. The predictive performance of fetal pancreatic circumference ≥ 80 and ≥ 90 centiles and glucose challenge test (GCT) was examined for the outcome of GDM. The independent-samples t-test was used to compare mean pancreatic circumference centile between pregnancies with GDM and those without GDM. Diagnostic performance was evaluated with 2 × 2 contingency tables and receiver-operating-characteristics (ROC) curves.
Overall, 195 women were selected for statistical analysis. Twenty-four (12.3%) women were diagnosed subsequently with GDM. The mean ± SD fetal pancreatic circumference centile was significantly higher in the GDM group compared with the non-GDM group (82.4 ± 14.6 vs 62.8 ± 27.6; P < 0.001). The pancreatic circumference centile was correlated positively with the estimated fetal weight centile (Pearson's coefficient, 0.243; P = 0.001). The 80 centile cut-off for pancreatic circumference had the highest sensitivity (70.8%) and positive predictive value (23.3%) for future maternal GDM, with the best trade-off between sensitivity and specificity achieved at the 75 centile cut-off (sensitivity, 79%; specificity, 60%). The GCT had better specificity (90.2%) and negative predictive value (97.9%) compared with both cut-offs in pancreatic circumference. The area under the ROC curve was higher for pancreatic circumference compared with GCT (0.71 vs 0.64) and only the former was statistically significant (P = 0.001).
Fetal pancreatic circumference has a higher positive predictive capacity compared with GCT. Measuring pancreatic circumference can identify pregnancies at high risk for maternal GDM, thereby promoting earlier diagnosis and treatment, decreasing the time period during which the fetus is exposed to high maternal glucose levels and improving infant outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
在进行标准血糖筛查和诊断之前，评估胎儿胰腺大小的能力，以预测孕妇妊娠期糖尿病（GDM）。
这是一项回顾性队列研究，纳入了 2017 年至 2020 年期间在以色列两个超声单位进行的常规 20-25 周妊娠胎儿解剖筛查期间招募的低危孕妇。检查了胎儿胰腺周长≥80 和≥90 百分位数和葡萄糖挑战试验（GCT）的预测性能，以预测 GDM 的结局。使用独立样本 t 检验比较了 GDM 组和非 GDM 组的平均胰腺周长百分位数。通过 2×2 列联表和接收者操作特征（ROC）曲线评估诊断性能。
共有 195 名妇女被选入统计分析。24 名（12.3%）妇女随后被诊断为 GDM。与非 GDM 组相比，GDM 组的胎儿胰腺周长百分位数明显更高（82.4±14.6 与 62.8±27.6；P<0.001）。胰腺周长百分位数与估计的胎儿体重百分位数呈正相关（皮尔逊系数，0.243；P=0.001）。胰腺周长的 80 百分位截断值对未来的母体 GDM 具有最高的敏感性（70.8%）和阳性预测值（23.3%），在 75 百分位截断值（敏感性，79%；特异性，60%）达到了敏感性和特异性之间的最佳权衡。与胰腺周长的两个截断值相比，GCT 具有更好的特异性（90.2%）和阴性预测值（97.9%）。ROC 曲线下面积（AUC）高于 GCT（0.71 与 0.64），且仅前者具有统计学意义（P=0.001）。
与 GCT 相比，胎儿胰腺周长具有更高的阳性预测能力。测量胰腺周长可以识别母体 GDM 风险较高的妊娠，从而促进早期诊断和治疗，减少胎儿暴露于高母体血糖水平的时间，并改善婴儿结局。 © 2024 作者。《超声妇产科杂志》由约翰威立父子公司出版，代表国际妇产科超声学会。
