Jones Danielle L, Kusinski Laura C, Barker Peter, Burling Keith, Halsall Ian, Turner Elizabeth, Glenn-Sansum Coralie, Rand Abby, Finch Jenny, Peters Genessa, Upson Geraldine, Mullins Edward, Meek Claire L
Institute of Metabolic Science - Medical Research Laboratories, University of Cambridge, Cambridge, UK.
Leicester Diabetes Centre, University Hospitals Leicester & University of Leicester, Leicester, UK.
Diabet Med. 2025 Mar;42(3):e15476. doi: 10.1111/dme.15476. Epub 2024 Dec 17.
Gestational diabetes is diagnosed using an oral glucose tolerance test (OGTT), which has limited accuracy, reproducibility and practicality. We assessed the effect of enhanced pre-analytical glucose processing upon glucose concentrations, gestational diabetes diagnosis, health equity and pregnancy outcomes, and if HbA1c was a suitable alternative.
We recruited pregnant women with ≥1 risk factor to a prospective observational cohort study of pregnancy hyperglycaemia, endocrine causes, lipids, insulin and autoimmunity (OPHELIA), from nine UK centres. During a 75 g antenatal OGTT (National Institute of Health and Care Excellence criteria), standard glucose processing was compared to enhanced glucose processing (storage on ice, rapid centrifugation, aliquoting and freezing <2.5 h).
We recruited 1308 participants of mean (SD) age 31.5 years (5.0) and BMI 33.0 kg/m (6.8) of 82.5% white ethnicity, representative of the UK population. Enhanced glucose processing resulted in glucose levels ~0.6 mmol/L higher than standard glucose processing, increasing gestational diabetes diagnosis from 9% to 22%. Women with gestational diabetes on enhanced but not standard glucose processing (n = 165) were younger (31.9 vs. 33.2 years, p = 0.035), with a higher BMI (36.5 vs. 33.9 kg/m; p = 0.003), different ethnic distribution (p = 0.025) and delivered more large-for-gestational age infants (37.0% vs. 22.3%; p = 0.006) compared to women with gestational diabetes on standard processing alone. HbA1c was not a suitable alternative predictor of gestational diabetes diagnosis (Area under receiver operator curve 0.74; 95% CI 0.68-0.79).
An OGTT with enhanced glucose processing would support more accurate, equitable diagnosis of gestational diabetes, but with increased diagnosis rates.
妊娠期糖尿病通过口服葡萄糖耐量试验（OGTT）进行诊断，但其准确性、可重复性和实用性有限。我们评估了强化分析前葡萄糖处理对血糖浓度、妊娠期糖尿病诊断、健康公平性和妊娠结局的影响，以及糖化血红蛋白（HbA1c）是否为合适的替代指标。
我们从英国9个中心招募了有≥1个危险因素的孕妇，进行一项关于妊娠高血糖、内分泌病因、血脂、胰岛素和自身免疫的前瞻性观察队列研究（OPHELIA）。在75g产前OGTT（英国国家卫生与临床优化研究所标准）期间，将标准葡萄糖处理与强化葡萄糖处理（在冰上储存、快速离心、分装并在<2.5小时内冷冻）进行比较。
我们招募了1308名平均（标准差）年龄为31.5岁（5.0）、BMI为33.0kg/m²（6.8）的参与者，其中82.5%为白人，具有英国人群代表性。强化葡萄糖处理使血糖水平比标准葡萄糖处理高约0.6mmol/L，妊娠期糖尿病诊断率从9%增至22%。与仅采用标准葡萄糖处理被诊断为妊娠期糖尿病的女性相比，采用强化而非标准葡萄糖处理被诊断为妊娠期糖尿病的女性更年轻（31.9岁对33.2岁，p = 0.035），BMI更高（36.5kg/m²对33.9kg/m²；p = 0.003），种族分布不同（p = 0.025），且分娩大于胎龄儿的比例更高（37.0%对22.3%；p = 0.006）。HbA1c并非妊娠期糖尿病诊断的合适替代预测指标（受试者工作特征曲线下面积为0.74；95%可信区间为0.68 - 0.79）。
采用强化葡萄糖处理的OGTT将有助于更准确、公平地诊断妊娠期糖尿病，但诊断率会增加。
