Greenberg L R, Moore T R, Murphy H
Department of Reproductive Medicine, University of California at San Diego School of Medicine, USA.
Obstet Gynecol. 1995 Jul;86(1):97-101. doi: 10.1016/0029-7844(95)00103-X.
To determine whether antepartum variables can predict postpartum glucose intolerance.
Glucose tolerance was assessed 6 weeks postpartum in 94 of 238 women with gestational diabetes using a 2-hour, 75-g oral glucose tolerance test (GTT). Selected antepartum variables were analyzed for predictive ability for postpartum glucose intolerance.
Of 238 patients, 94 (39%) returned for a GTT. Those returning and those not returning were similar in all variables. Postpartum glucose intolerance occurred in 34%: impaired glucose tolerance in 18%, overt diabetes in 16%. No single maternal, intrapartum, or neonatal variable was predictive of postpartum glucose intolerance in all cases. Predictive variables included: requirement for insulin (insulin versus diet: 25 versus 3% impaired glucose tolerance, 26 versus 0% diabetes; P = .001), poor glycemic control (any 2-hour postprandial blood sugar level of 150 mg/dL or higher: 34 versus 5% diabetes; P = .005), and the 50-g GTT value (200 mg/dL or higher: 32 versus 6% diabetes; P = .01). For insulin requirement, the relative risk (RR) was 17.28 (95% confidence interval [CI] 2.46-121.45), and for the above three variables combined, the RR was 19.68 (95% CI 2.88-134.2). When the insulin dose was at least 100 U/day, all patients had abnormal glucose tolerance postpartum (RR = 34.00, 95% CI 4.93-234.39).
Postpartum glucose screening is not warranted for women at low risk who do not require insulin during pregnancy. The incidence of postpartum glucose intolerance in this group is very low. Women with risk factors should receive postpartum screening. Patients receiving at least 100 U/day of insulin have a 100% incidence of postpartum glucose intolerance.
确定产前变量是否能够预测产后糖耐量异常。
对238例妊娠期糖尿病妇女中的94例在产后6周采用2小时75克口服葡萄糖耐量试验（GTT）评估糖耐量。分析选定的产前变量对产后糖耐量异常的预测能力。
238例患者中，94例（39%）返回进行GTT检查。返回检查者与未返回者在所有变量方面相似。产后糖耐量异常发生率为34%：糖耐量受损者占18%，显性糖尿病患者占16%。没有单一的母体、产时或新生儿变量能在所有病例中预测产后糖耐量异常。预测变量包括：胰岛素需求情况（胰岛素治疗组与饮食治疗组：糖耐量受损者分别为25%与3%，糖尿病患者分别为26%与0%；P = 0.001）、血糖控制不佳（任何餐后2小时血糖水平达到或高于150mg/dL：糖尿病患者分别为34%与5%；P = 0.005）以及50克GTT值（达到或高于200mg/dL：糖尿病患者分别为32%与6%；P = 0.01）。对于胰岛素需求情况，相对危险度（RR）为17.28（95%可信区间[CI] 2.46 - 121.45），对于上述三个变量综合起来，RR为19.68（95%CI 2.88 - 134.2）。当胰岛素剂量至少为100U/天时，所有患者产后糖耐量均异常（RR = 34.00，95%CI 4.93 - 234.39）。
对于孕期不需要胰岛素治疗的低风险女性，无需进行产后血糖筛查。该组产后糖耐量异常发生率非常低。有风险因素的女性应接受产后筛查。接受至少100U/天胰岛素治疗的患者产后糖耐量异常发生率为100%。
