低风险的产前患者真的需要进行葡萄糖筛查试验吗？

Do low-risk prenatal patients really need a screening glucose challenge test?

作者信息

Helton M R, Arndt J, Kebede M, King M

机构信息

Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill 27599-7595, USA.

出版信息

J Fam Pract. 1997 Jun;44(6):556-61.

PMID:9191628

Abstract

BACKGROUND

It is common practice to routinely screen pregnant women for gestational diabetes. The screening technique typically used is the 1-hour 50-g oral glucose tolerance test (OGTT), with a subsequent 3-hour 100-g OGTT for women whose 1-hour test was positive. This process can be both time-consuming and inconvenient for patients. Additionally, its sensitivity and specificity are estimated to be 70% and 87% respectively, and data about the effect of screening and treatment on low-risk pregnancy outcomes are limited. The objective of this study was to reassess the value of routine screening of all pregnant patients with a 1-hour glucose challenge test.

METHODS

At a university-based family practice center with a predominantly low-risk population, a retrospective analysis was performed of all patients (n = 595) who received prenatal care and gave birth between January 1988 and December 1993. Among women in whom gestational diabetes was diagnosed on the basis of glucose tolerance testing, we identified those with risk factors for the disease, and examined whether a selective screening program based on risk factors alone would have resulted in correct diagnoses of gestational diabetes.

RESULTS

Of the 595 patients, 544 (91.4%) were screened with a 1-hour 50-g OGTT. This initial screening test was positive in 76 women (12.8%). Of these, 58 (76.3%) then had a 3-hour 100-g OGTT, and 13 received a diagnosis of gestational diabetes. Nine of these 13 women had risk factors for gestational diabetes. We determined that less than 1% of prenatal patients without risk factors for gestational diabetes were ultimately found to have gestational diabetes.

CONCLUSIONS

Screening with a 1-hour 50-g OGTT only those women who have identifiable risk factors for gestational diabetes is a reasonable approach to identifying the disease in a low-risk population. All pregnant women should have a thorough history taken to determine whether they have risk factors for gestational diabetes.

摘要

背景

对孕妇进行妊娠期糖尿病常规筛查是常见做法。通常使用的筛查技术是1小时50克口服葡萄糖耐量试验（OGTT），对于1小时试验呈阳性的女性，随后进行3小时100克OGTT。这个过程对患者来说既耗时又不方便。此外，其敏感性和特异性估计分别为70%和87%，关于筛查和治疗对低风险妊娠结局影响的数据有限。本研究的目的是重新评估对所有孕妇进行1小时葡萄糖耐量试验常规筛查的价值。

方法

在一个以低风险人群为主的大学家庭医疗中心，对1988年1月至1993年12月期间接受产前护理并分娩的所有患者（n = 595）进行回顾性分析。在根据葡萄糖耐量试验诊断为妊娠期糖尿病的女性中，我们确定了那些患有该疾病危险因素的女性，并检查仅基于危险因素的选择性筛查方案是否能正确诊断妊娠期糖尿病。

结果

595名患者中，544名（91.4%）接受了1小时50克OGTT筛查。这项初始筛查试验在76名女性中呈阳性（12.8%）。其中，58名（76.3%）随后进行了3小时100克OGTT，13名被诊断为妊娠期糖尿病。这13名女性中有9名有妊娠期糖尿病的危险因素。我们确定，最终发现没有妊娠期糖尿病危险因素的产前患者中，患妊娠期糖尿病的不到1%。