Saxena Pikee, Yadav Akshma, Singh Meenakshi, C Anjalakshi, Chawla Rajeev, Divakar Hema, Seshiah Veeraswamy
Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, IND.
Obstetrics and Gynaecology, Madras Medical College, Madras, IND.
Cureus. 2024 Aug 11;16(8):e66652. doi: 10.7759/cureus.66652. eCollection 2024 Aug.
To determine the correlation between first-trimester two-hour postprandial blood glucose (PPBG) > 110 mg/dL for predicting gestational diabetes mellitus (GDM).
This prospective cohort study enrolled 200 women between 8 and 10 weeks of gestation from February 2022 to February 2024. All recruited pregnant women underwent testing for two-hour PPBS at 8-10 weeks and were followed up till delivery. GDM screening was done during 14-16, 24-28, and 32-34 weeks of gestation.
Amongst women having PPBS > 110 mg/dL, 95.9% developed GDM, while in the group with PPBS < 110 mg/dL, only 4% developed GDM. In the PPBS > 110 mg/dL group, a significantly higher number of women were in the older age group (p < 0.049), had a higher BMI (p < 0.001), a family history of diabetes (p < 0.001), and previous history of abortion (p < 0.001). Women with PPBS > 110 mg/dL had significantly higher rates of cesarean section (p < 0.01), preterm delivery (p < 0.001), and macrosomia (p < 0.001). A positive correlation (r = 0.677; p < 0.001) was observed between first trimester two-hour PPBS and cord blood glucose levels. Similarly, a positive correlation (r = 0.465; p < 0.001) was present between insulin levels measured during the first trimester with cord blood insulin. The area under the curve (AUC) for PPBS was 0.969 (p < 0.001) with 95% CI: 0.933-0.988. PPBS > 110 mg/dL has a sensitivity of 95.9%, specificity of 95.6%, positive predictive value (PPV) of 95.9%, negative predictive value (NPV) of 95.7%, and diagnostic accuracy of 95.77% to predict GDM.
PPBS > 110 mg/dL at two hours exhibits high levels of diagnostic accuracy for the prediction of GDM and is associated with adverse fetomaternal outcomes. PPBG is a superior, physiologic, and low-cost option compared to HbA1c for early prediction of GDM and can also be performed as a simple point-of-care test with a glucometer at home or in the periphery by healthcare workers (HCW) and in wellness centers.
确定孕早期餐后两小时血糖（PPBG）>110mg/dL与预测妊娠期糖尿病（GDM）之间的相关性。
这项前瞻性队列研究纳入了2022年2月至2024年2月期间妊娠8至10周的200名女性。所有招募的孕妇在8至10周时接受了两小时PPBS检测，并随访至分娩。在妊娠14至16周、24至28周和32至34周期间进行GDM筛查。
在PPBS>110mg/dL的女性中，95.9%发生了GDM，而在PPBS<110mg/dL的组中，只有4%发生了GDM。在PPBS>110mg/dL组中，年龄较大的女性数量显著更多（p<0.049），BMI更高（p<0.001），有糖尿病家族史（p<0.001），以及有既往流产史（p<0.001）。PPBS>110mg/dL的女性剖宫产率（p<0.01）、早产率（p<0.001）和巨大儿发生率（p<0.001）显著更高。孕早期两小时PPBS与脐血血糖水平之间存在正相关（r=0.677；p<0.001）。同样，孕早期测量的胰岛素水平与脐血胰岛素之间也存在正相关（r=0.465；p<0.001）。PPBS的曲线下面积（AUC）为0.969（p<0.001），95%CI为：0.933-0.988。PPBS>110mg/dL预测GDM的敏感性为95.9%，特异性为95.6%，阳性预测值（PPV）为95.9%，阴性预测值（NPV）为95.7%，诊断准确性为95.77%。
两小时PPBS>110mg/dL对预测GDM具有较高的诊断准确性，并与不良母婴结局相关。与糖化血红蛋白相比，PPBG是一种用于早期预测GDM的更优、生理性且低成本的选择，并且也可以由医护人员（HCW）在家中或基层医疗点使用血糖仪作为简单的即时检测进行，也可在健康中心进行。
