Prior Alissa K, Dolin Cara D, Bender Whitney, Durnwald Celeste P, Hamm Rebecca F
Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio.
Am J Perinatol. 2025 Apr;42(6):708-712. doi: 10.1055/a-2416-5742. Epub 2024 Sep 17.
The Endocrine Society recommends a postpartum fasting blood glucose (FBG) be performed for patients with gestational diabetes mellitus (GDM) prior to hospital discharge to screen for ongoing hyperglycemia. There are limited data, however, on whether an FBG can screen for glucose intolerance and if it correlates with the gold standard 4- to 12-week 2-hour oral glucose tolerance test (OGTT). Our objective was to evaluate if FBG correlates with the gold standard 2-hour OGTT.This retrospective cohort study of patients with GDM who delivered >20 weeks' gestation at two urban centers from January 2017 to December 2020 included those who completed both a postpartum FBG prior to discharge and a 2-hour 75-g OGTT within 1 year of delivery. Abnormal 2-hour OGTT was defined as fasting value ≥100 mg/dL and/or 2-hour value ≥140 mg/dL. We evaluated test characteristics (e.g., sensitivity, specificity) of postpartum FBG cut-offs to predict an abnormal 2-hour OGTT result.A total of 235 patients met inclusion criteria, of which 63% were diet-controlled and 37% required medical management. FBG ranged from 64 to 134 mg/dL, with 6/235 (2.6%) with values ≥126 mg/dL. A total of 39/235 (16.6%) of patients had an abnormal 2-hour OGTT. Overall, area under the curve for FBG predicting abnormal 2-hour OGTT was 0.65. Traditionally considered high cut-offs (≥126 mg/dL) for predicting persistent impaired glucose intolerance demonstrated poor positive predictive value (PPV; <20%). In contrast, low cut-offs demonstrated excellent NPV (>90%). A postpartum FBG of 88 mg/dL was determined to be the optimal cut-off for FBG with NPV = 92.4% (Youden index = 0.34). In this dataset, if FBG ≥ 88 mg/dL was used to determine if 2-hour OGTT was required, almost half of GDM patients could avoid further glucose tolerance testing.While previously thought of as best utilized for its PPV, the FBG may be best used for its NPV. In our study, clinical application of an FBG < 88 mg/dL was highly correlative with a normal 2-hour OGTT. · Screening for postpartum glucose intolerance is essential for gestational diabetes.. · A promising initiative includes offering screening tests while in the hospital, including an FBG.. · Application of a postpartum FBG < 88 mg/dL is highly correlative with a normal 2-hour OGTT..
美国内分泌学会建议，对于患有妊娠期糖尿病（GDM）的患者，在出院前进行产后空腹血糖（FBG）检测，以筛查持续性高血糖。然而，关于FBG能否筛查葡萄糖耐量异常以及它是否与金标准的4至12周2小时口服葡萄糖耐量试验（OGTT）相关的数据有限。我们的目的是评估FBG是否与金标准的2小时OGTT相关。这项回顾性队列研究纳入了2017年1月至2020年12月在两个城市中心分娩孕周>20周的GDM患者，包括那些在出院前完成产后FBG检测以及在分娩后1年内完成2小时75克OGTT检测的患者。2小时OGTT异常定义为空腹值≥100mg/dL和/或2小时值≥140mg/dL。我们评估了产后FBG临界值预测2小时OGTT异常结果的检测特征（如敏感性、特异性）。共有235名患者符合纳入标准，其中63%通过饮食控制，37%需要药物治疗。FBG范围为64至134mg/dL，其中6/235（2.6%）的值≥126mg/dL。共有39/235（16.6%）的患者2小时OGTT异常。总体而言，FBG预测2小时OGTT异常的曲线下面积为0.65。传统上认为用于预测持续性葡萄糖耐量受损的高临界值（≥126mg/dL）显示出较差的阳性预测值（PPV；<20%）。相比之下，低临界值显示出出色的阴性预测值（>90%）。产后FBG为88mg/dL被确定为FBG的最佳临界值，阴性预测值为92.4%（约登指数=0.34）。在该数据集中，如果使用FBG≥88mg/dL来确定是否需要进行2小时OGTT检测，几乎一半的GDM患者可以避免进一步的葡萄糖耐量测试。虽然以前认为FBG最适合用于其PPV，但它可能最适合用于其NPV。在我们的研究中，FBG<88mg/dL的临床应用与2小时OGTT正常高度相关。· 筛查产后葡萄糖耐量异常对妊娠期糖尿病至关重要。· 一项有前景的举措包括在医院提供筛查测试，包括FBG。· 应用产后FBG<88mg/dL与2小时OGTT正常高度相关。
