Lucas M J, Lowe T W, Bowe L, McIntire D D
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas.
Obstet Gynecol. 1993 Aug;82(2):260-5.
To compare pregnancy outcomes in women diagnosed as having class A1 gestational diabetes with those of a group with a normal 3-hour glucose tolerance test (GTT) to assess morbidities attributable to glucose intolerance.
Selective 50-g GTT identified pregnant women who received a 3-hour GTT. Over a 16-month period, 159 women were diagnosed as having class A1 gestational diabetes according to the National Diabetes Data Group criteria. During the latter 12 months of this time period, 151 women who had a normal GTT result were identified for comparison.
There were statistically significant differences in age and the development of peripartum hypertension in women with class A1 gestational diabetes compared with the normal 3-hour GTT group. There were no significant differences in any neonatal outcome variable, including percent delivering large for gestational age (LGA) neonates in women with A1 diabetes compared to controls. Overall, 111 (36%) of the 310 neonates were classified as LGA, a rate more than double that in the singleton population in our hospital. Maternal weight, parity, and a history of a previous macrosomic infant were significantly associated with LGA outcome. Mean maternal weight was the same in the two GTT groups, implying an independent effect on fetal size. Obstetric interventions were not significantly different between the groups, so differences in intervention could not account for the lack of difference in outcome variables. The impact of dietary counseling in the class A1 diabetic women is also an unlikely explanation for the lack of differences in outcome. Within the normal-GTT group, women with one abnormal 3-hour value had a frequency of LGA infants similar to that of women with all normal 3-hour GTT values. These results suggest that there is a selection effect of screening for glucose intolerance that may relate more to other risk factors for LGA outcome than to glucose intolerance. Maternal obesity is an independent and more potent risk factor for large infants than is glucose intolerance.
The diagnosis of class A1 gestational diabetes is not significantly associated with obstetric and perinatal morbidities. A nondiscriminating diagnostic test undermines the validity of population screening for glucose intolerance.
比较诊断为A1级妊娠期糖尿病的女性与糖耐量试验（GTT）3小时结果正常的女性的妊娠结局，以评估糖耐量异常所致的发病率。
通过50克葡萄糖负荷试验筛选出接受3小时GTT的孕妇。在16个月的时间里，根据美国国家糖尿病数据组标准，159名女性被诊断为A1级妊娠期糖尿病。在此时间段的后12个月里，确定了151名GTT结果正常的女性作为对照。
与GTT 3小时结果正常组相比，A1级妊娠期糖尿病女性在年龄和产后高血压发生率方面存在统计学显著差异。在任何新生儿结局变量方面均无显著差异，包括与对照组相比，A1级糖尿病女性中大于胎龄（LGA）新生儿的分娩百分比。总体而言，310名新生儿中有111名（36%）被归类为LGA，这一比例是我院单胎人群的两倍多。孕妇体重、产次和既往巨大儿史与LGA结局显著相关。两组GTT女性的平均孕妇体重相同，这意味着对胎儿大小有独立影响。两组间产科干预无显著差异，因此干预差异不能解释结局变量缺乏差异的原因。A1级糖尿病女性饮食咨询的影响也不太可能解释结局缺乏差异的原因。在GTT正常组中，3小时值有一项异常的女性中LGA婴儿的发生率与3小时GTT值均正常的女性相似。这些结果表明，糖耐量异常筛查存在选择效应，这可能更多地与LGA结局的其他危险因素有关，而非糖耐量异常。孕妇肥胖是比糖耐量异常更独立、更强有力的巨大儿危险因素。
A1级妊娠期糖尿病的诊断与产科及围产期发病率无显著相关性。不加区分的诊断试验会削弱人群糖耐量异常筛查的有效性。
