Siribaddana S H, Deshabandu R, Rajapakse D, Silva K, Fernando D J
Faculty of Medicine, University of Colombo, Sri Lanka.
Ceylon Med J. 1998 Jun;43(2):88-91.
Early diagnosis of gestational diabetes mellitus (GDM) is a prerequisite to reducing fetal and neonatal complications of GDM.
(a) To ascertain the prevalence of GDM in a Sri Lankan pregnant population. Using the 75 g oral glucose tolerance test (GTT) and WHO criteria. (b) To establish the predictive value of a 50 g glucose challenge test (GCT) compared to the GTT (c) To compare the outcome of pregnancy in GDM with 'non-diabetic pregnancy' (NDP) STUDY DESIGN: Prospective study on a cohort of pregnant women attending antenatal clinics.
Sri Jayawardenepura General Hospital (SJGH) RESULTS: Of the 721 patients, 131 (18%) had a positive GCT. 40 (5.5%) patients had GDM. If a one-hour GCT of 7.8 mmol/l was considered suspicious of GDM the sensitivity of the glucose challenge test was 63% and the specificity 84%. Statistically significant differences in the prevalence was found when the women were > 35 years [Relative risk (RR) = 3.87 (95% CI-2.06 to 7.27)] or the body mass index > or = 25. (RR = 2.45 (95 CI-1.30 to 4.61) Presence or absence of high parity, family history of diabetes or recurrent abortions had no significant impact on the prevalence of GDM. Mean birth weight was higher (p < 0.05) in GDM (3615 SD 103) than in NDP (2898 SD 143.6). The likelihood of having a caesarean section was higher (p < 0.01, Relative risk (RR) 2.50, 95% CI 1.56-3.95) in GDM when compared to NDP. A higher incidence of hydramnios (p < 0.01 RR 3.41 95% CI 1.44-8.05) was recorded in GDM when compared to NDP.
The prevalence of GDM in the antenatal clinics at SJGH is 5.5%. Traditional risk factors did not predict GDM. GDM is associated with a higher risk of caesarean section, hydramnios and macrosomia. Hence screening for GDM should be performed in all pregnant women at 24 to 28 weeks of pregnancy using a GCT.
妊娠期糖尿病（GDM）的早期诊断是降低GDM胎儿及新生儿并发症的前提条件。
（a）采用75克口服葡萄糖耐量试验（GTT）及世界卫生组织标准，确定斯里兰卡孕妇群体中GDM的患病率。（b）确定50克葡萄糖筛查试验（GCT）相较于GTT的预测价值。（c）比较GDM孕妇与“非糖尿病妊娠”（NDP）孕妇的妊娠结局。研究设计：对一组产前检查门诊孕妇进行前瞻性研究。
斯里贾亚瓦德纳普拉总医院（SJGH）结果：721例患者中，131例（18%）GCT结果呈阳性。40例（5.5%）患者患有GDM。若将1小时GCT血糖值7.8毫摩尔/升视为GDM可疑值，则葡萄糖筛查试验的敏感度为63%，特异度为84%。年龄>35岁的女性（相对危险度（RR）=3.87（95%可信区间-2.06至7.27））或体重指数≥25的女性（RR = 2.45（95%可信区间-1.30至4.61））GDM患病率差异有统计学意义。是否有高胎次、糖尿病家族史或反复流产对GDM患病率无显著影响。GDM组平均出生体重（3615±103）高于NDP组（2898±143.6）（p<0.05）。与NDP相比，GDM孕妇剖宫产的可能性更高（p<0.01，相对危险度（RR）2.50，95%可信区间1.56 - 3.95）。与NDP相比，GDM孕妇羊水过多的发生率更高（p<0.01，RR 3.41，95%可信区间1.44 - 8.05）。
SJGH产前检查门诊GDM患病率为5.5%。传统危险因素无法预测GDM。GDM与剖宫产、羊水过多及巨大儿风险较高相关。因此，应在所有孕妇妊娠24至周时采用GCT进行GDM筛查。 28
