The clinical impact of screening for gestational diabetes.

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance during pregnancy. In Denmark the health service offers selective screening for GDM, i.e., admission to an oral glucose tolerance test (OGTT) after pre-screening with interview for clinical risk factors for GDM, two capillary fasting blood glucose (cFBG) measurements and a urine test for glucosuria. The aim of the present study was to investigate the power of the pre-screening to identify GDM and the screening to predict adverse clinical outcome. A retrospective investigation of pregnant women undergoing screening during 1998 at Vejle County Hospital, Denmark was undertaken. The two most frequent pre-screening criteria for OGTT were body-mass index (BMI) > or = 27 kg/m2 and age > or = 35 years. The highest odds ratio (OR) of 9.07 (95% CI: 2.60 to 63.70) for GDM had glucosuria and the lowest (zero) had cFBG. The frequency of complicated delivery was similar in GDM (58%) compared to non-GDM (56%). The best predictor of complicated delivery was a BMI with OR = 1.50 (95% CI: 0.87 to 2.60) for BMI > or = 27 kg/m2 vs. < 27 kg/m2. The best predictor of adverse neonatal outcome was a capillary blood glucose 120 min after glucose load (cBG(120 min)) > or = 9.0 mmol/l (OR = 3.18, 95% CI: 1.14 to 8.89). The intermediary endpoint GDM was not superior for predicting adverse maternal and neonatal outcome. The cumulative probability distribution of cBG(120 min) after a 75 g glucose load was not homogeneously distributed in groups stratified according to maternal and foetal outcome. A changed slope was seen after cBG(120 min) 9.0 mmol/l. Screening cFBG of 4.1 mmol/l was unable to predict GDM and adverse outcome. Glucosuria was too rare to be effective as a screening tool. Pre-screening did not identify GDM. The best predictor of complicated delivery was a high BMI. The best predictor of foetal adverse outcome was cBG120 miin > or = 9.0 mmol/l after a 75 g glucose load. Identical fraction complications were present in GDM and non-GDM. A refinement of the screening procedure is highly needed, and this has been initiated in Denmark.     

妊娠糖尿病筛查与妊娠糖尿病母儿结局的分析研究

目的:分析妊娠糖尿病筛查对妊娠糖尿病母儿结局的影响.方法:抽选2019年1月至2019年12月在本所建卡、已分娩的妊娠期糖尿病产妇作为病例组(64例);另选择同期在本所建卡、已分娩的健康产妇作为对照组(64例)进行回顾性研究,两组在孕期均使用妊娠期糖尿病筛查,比较两组新生儿评分、不良妊娠结局以及并发症发生率.结果:对照...     

Postpartum glucose screening among women with gestational diabetes

Objective(1) Determine the rate of completion of glucose screening for diabetes in the postpartum period for women who had gestational diabetes mellitus, and (2) compare the rates of follow up glucose screening among women who had A1GDM or A2GDM 4-12 weeks postoartum.DesignA retrospective comparative study.SettingAn academic hospital in an urban community.ParticipantsOne hundred and seventy-five women with gestational diabetes who gave birth between January 2012 and September 2015.MethodsThe electronic medical record was reviewed to confirm diagnosis of gestational diabetes at 24–28 weeks and completion of 4–12 weeks postpartum glucose screening. All consecutive women meeting eligibility criteria were included.ResultsThe rate of postpartum glucose screening was 38.9%. There were 22 (31.0%) women with A1GDM and 46 (44.2%) women with A2GDM who had postpartum glucose screening (χ² = 3.12, p = 0.08).ConclusionsThe type of GDM, did not affect the rate of follow-up for postpartum glucose screening. Strategies need to be developed to improve postpartum screening rates in women with gestational diabetes.     

糖化白蛋白在妊娠期糖尿病筛查及诊断中的价值探讨

目的：评价糖化白蛋白（GA）测定在妊娠期糖尿病诊断中的价值。方法选取2011年9月-2012年3月在我院进行产前检查并于24-28周接受50 g 葡萄糖糖尿病筛查结果异常的孕妇160例,以第7版《妇产科学》的诊断标准分为糖耐量正常组,糖耐量受损组,糖尿病组。对三组的空腹血糖（FPG）,糖化血红蛋白（HbA1c）,糖化白蛋白（GA）等进行对比研究,评价 GA 在妊娠期糖尿病诊断中的价值。结果三组的 FPG、HbA1c、GA 结果有显著性差异,三组中 GA 与 HbA1c 均具有相关性。结论糖化白蛋白（GA）的测定对妊娠糖尿病病变程度的变化具有提示作用,对妊娠期糖尿病的筛查和诊断具有价值,可作为临床应用。     

Testing for gestational diabetes

In 1996, the American Diabetes Association reported that 12% of total health care expenditure in the United States was spent on diabetes and its complications. Screening for and treating gestational diabetes results in improved perinatal morbidity and mortality. Moreover, detecting gestational diabetes identifies women who are at risk of future type 2 diabetes. This article reviews several approaches to diagnosing gestational diabetes.     

饮食控制在妊娠糖尿病中的作用

目的：研究饮食控制对妊娠糖尿病（GDM）的治疗作用。方法：对我2007年1-12月收治的56例妊娠糖尿病患者采用心理护理及饮食控制。收集经营养门诊及病房会诊指导后的GDM患者的血糖值（包括空腹血糖和餐后2h血糖）和未经营养指导GDM患者的血糖值。结桌：营养指导后的GDM患者的血糖水平明显低于非指导组，且营养指导后血糖水平低于指导前（P〈0.05）。结论：饮食控制对妊娠糖尿病具有治疗作用。     

Screening for gestational diabetes mellitus

Gestational diabetes occurs in 3 to 6 percent of pregnancies and is associated with increased rates of macrosomia, serious birth trauma and cesarean section. Neonatal hyperbilirubinemia, hypocalcemia and hypoglycemia also occur more frequently in this disorder. Perinatal outcome is improved through the identification and management of affected women. It is therefore recommended that all pregnant women be screened for this condition at 24 to 28 weeks of gestation. In addition to plasma glucose levels, a new measurement of glycemic control--the serum fructosamine level--may prove useful in identifying and managing women with gestational diabetes.     

Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness

OBJECTIVE: To compare the performance in screening for gestational carbohydrate intolerance of the 1-h 50-g glucose challenge test (GCT), fasting plasma glucose (FPG) and fasting capillary glucose (FCG). DESIGN AND METHODS: FPG and FCG were measured at the same time as the GCT in 188 women. Gestational carbohydrate intolerance was diagnosed according to the Canadian Diabetes Association criteria. We constructed receiver operator characteristic (ROC) curves and compared the sensitivity and specificity of the FPG, FCG and GCT. RESULTS: Gestational diabetes was diagnosed in 11.2% women and gestational impaired glucose tolerance in 8.4%. The areas under the ROC curves for the FPG, the GCT and the FCG were not statistically different (P = 0.26). The GCT yielded a better specificity than the FPG and the FCG for a comparable level of sensitivity. CONCLUSIONS: The GCT is better than the FPG in our population and is cost effective.     

HbA1c在妊娠期糖尿病筛查中的临床价值

目的评估糖化血红蛋白（HbA1c）在妊娠期糖尿病（GDM）筛查中应用的可能性。方法对同时进行75 g口服葡萄糖耐量试验（OGTT）和HbA1c检查的474例围产期门诊孕妇按美国糖尿病协会（ADA）标准分为GDM组（30例）和非GDM组（444例）,分析2组HbA1c结果。结果 GDM组HbA1c水平明显高于非GDM组（P〈0.01）;HbA1c筛查GDM的受试者工作特征（ROC）曲线下面积为0.969;当HbA1c的Cut-off值为5.4%时,筛查GDM的敏感性为73.0%、特异性为98.4%、阳性预示值为75.9%、可靠性为98.2%。结论 HbA1c可作为一个非常有希望的GDM筛查指标。     

The utility HBA1c test as a screening biomarker for detecting gestational diabetes mellitus

BackgroundGlycated Hb (HbA1c) has not been used for the diagnosis of gestational diabetes mellitus (GDM). Measurement of HbA1c levels is less complicated and more comfortable than glucose challenge test (GCT) for pregnant women. We studied HbA1c as a biomarker of GDM and as a screening test to avoid the use of GCT.MethodsA prospective case-control study involves 745 pregnant women between 24th and 28th gestation week. HbA1c levels were measured and GDM was diagnosed according to Carpenter–Coustan criteria. Mean and SD were calculated for GCT value, HbA1c, age, and body mass index (BMI). A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of HbA1c test in diagnosing GDM. Cut-off points were calculated to rule out GDM and sensitivity (Se) and specificity (Sp) were also determined. A study of the implementation of HbA1c cut-offs was performed to avoid the GCT or to perform the confirmatory oral glucose tolerance test (OGTT).ResultsThe area under the curve (AUC) was 0.67 (0.58–0.76). Using 4.6% HbA1c as a cut-off prevented false negatives but only decreased the number of GCTs performed by 7.2%. However, using 4.7% HbA1c resulted in one false negative (reduction of 15.0%). Finally, by selecting 4.8% HbA1c, we found two false negatives, but there were 25.9% who do not require a GCT.ConclusionsAdoption of HbA1c as a screening test for GDM may eliminate the need of GCT. Although the HbA1c test does not have sufficient Se and Sp to be used as the only diagnostic test, the use of a rule-out strategy in combination with the OGTT could be useful.     

HbA1c在妊娠期糖尿病筛查中的临床价值

目的评估糖化血红蛋白(HbA1c)在妊娠期糖尿病(GDM)筛查中应用的可能性。方法对同时进行75 g口服葡萄糖耐量试验(OGTT)和HbA1c检查的474例围产期门诊孕妇按美国糖尿病协会(ADA)标准分为GDM组(30例)和非GDM组(444例),分析2组HbA1c结果。结果 GDM组HbA1c水平明显高于非GDM组(P<0.01);HbA1c筛查GDM的受试者工作特征(ROC)曲线下面积为0.969;当HbA1c的Cut-off值为5.4%时,筛查GDM的敏感性为73.0%、特异性为98.4%、阳性预示值为75.9%、可靠性为98.2%。结论 HbA1c可作为一个非常有希望的GDM筛查指标。     

黄芪四君子汤对妊娠期糖尿病的疗效分析

目的分析黄芪四君子汤治疗妊娠糖尿病(GDM)的疗效及对Mg~(2+)、CRP、脂联素水平、并发症发生的影响。方法将唐山市妇幼保健院2015年8月至2017年1月接诊的130例GDM患者纳入研究,随机将患者分为观察组和对照组各65例,给予对照组患者常规治疗,观察组患者在常规治疗的基础上加用黄芪四君子汤治疗,观察两组患者治疗前后空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)及血清Mg~(2+)、CRP和脂联素水平以及治疗后并发症发生情况。结果治疗后,观察组的FPG[(5.30±0.3)mmol/L]、2hPG[(5.36±0.27)mmol/L]、HbA1c[(5.58±1.29%)]水平均低于对照组FPG[(5.68±0.38)mmol/L]、2hPG[(6.01±0.33)mmol/L]、HbA1c[(6.86±1.35)%],两组间比较差异有统计学意义(P0.05);观察组的Mg~(2+)水平[(1.25±0.36)mmol/L]和脂联素水平[(35.24±5.18)μg/L]高于对照组Mg~(2+)水平[(0.91±0.30)mmol/L]和脂联素水平[(30.76±4.85)μg/L],CRP水平[(1.59±0.35)mg/L]低于对照组[(2.21±0.46)mg/L],两组比较差异均有统计学意义(P0.05);观察组患者出现腹痛、腹胀、低血糖的不良反应发生率(9.23%)低于对照组(38.46%),两组比较差异有统计学意义(P0.05);观察组患者治疗后的临床疗效总有效率(96.92%)高于对照组(87.69%),两组比较差异有统计学意义(P0.05)。结论黄芪四君子汤在GDM治疗中能有效降低血糖,改善Mg~(2+)、CRP、脂联素等相关指标,降低并发症发生率,效果显著,值得临床上的广泛应用。