妊娠期葡萄糖耐量试验血糖值与新生儿出生体重的关系

妊娠期糖尿病(gestational diabetes mellitus,GDM)是妊娠期特有疾病,指妊娠期发生或首次发现的不同程度的糖耐量异常,包含了一部分妊娠前已经患有糖尿病但妊娠期首次被诊断的患者.由于GDM的发病率逐年上升,且与巨大儿、剖宫产率增加、子痫前期等一系列不良妊娠结局的发生及母儿远期不良预后密切相关[1 2],故目前周内已广泛开展GDM的筛查工作.本研究对孕妇进行50 g葡萄糖负荷试验(glucose challenge test,GCT),对筛查异常的孕妇进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT),随访其妊娠结局,探讨OGTT各时点血糖值及OGTT结果的曲线下面积(area under the curve of the results of the oral glucose tolerance test,AUC-OGTT)与新生儿出生体重之间的关系.     

二次OGTT诊断妊娠期糖尿病围生结局分析

【摘 要】 目的：探讨二次口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）诊断妊娠期糖尿病（gestational diabetes mellitus,GDM）的围生结局。方法：初次OGTT诊断GDM者188例,作为GDM1组。二次OGTT诊断GDM者38例,作为GDM2组;同期血糖正常产妇200例,作为对照组。比较3组产妇围生结局,如产后出血、早产、胎膜早破、巨大儿等。结果：GDM2组的产后出血、胎膜早破、大于胎龄儿发生率高于对照组,差异有统计学意义（P＜0.05）;GDM2组的巨大儿发生率高于GDM1组,差异有统计学意义（P＜0.05）。结论：二次OGTT可以提高GDM的诊断率,从而尽早诊断、积极干预GDM,改善妊娠结局。     

妊娠期糖尿病筛查与诊断的进展

妊娠期糖尿病(GDM)是常见的产科并发症,其发生率为1%～13.9%,不良的妊娠结局与血糖水平相关,GDM的筛查时间应在妊娠18周前,筛查对象为普查或选择性筛查,以空腹血糖(FBG)代替糖负荷试验(GCT),以FBG≥5.6mmol/L为阈值,进行口服糖耐量试验(OGTT)检查,能够取得理想的敏感度和特异度,诊断方法分为一步法和两步法,测血浆血糖优于测全血血糖,Carpenter标准更适用于GDM的临床诊断.     

单纯糖筛查异常临床干预对妊娠结局的影响

妊娠期糖尿病（gestational diabktes mellius，GDM）和妊娠期糖耐量单项异常（gestational impares glucose tolerance，GIGT）对胎儿、新生儿的影响已引起产科医师的广泛重视。但50g葡萄糖筛查（glucose challenge test，GCT）异常、葡萄糖耐量试验（oral glucose tolerance text，OGTT）正常的孕妇（单纯GCT异常），其妊娠结局可以与GDM和GIGT有相似之处，对胎儿及新生儿的影响尚未引起足够的重视。为减少巨大儿及母儿并发症的发生，本文通过对单纯GCT异常孕妇进行妊娠期营养和糖尿病一级预防相关知识的普及，达到了降低剖宫产率和巨大儿发生的目的，报道如下。     

围孕期空腹血糖对妊娠期糖尿病发生的预测作用及其与不良妊娠结局的关系

目的:通过队列研究前瞻性分析围孕期空腹血糖(FPG)对妊娠期糖尿病(GDM)发生的预测作用及其与不良妊娠结局的关系,探讨从孕前、孕早期开始防控GDM的相对安全的孕前及孕早期FPG值。方法:选取2020年1月至2021年1月在重庆市妇幼保健院妇产科进行孕前体检并于检查后半年内妊娠的565例女性为研究对象,进行规范孕前检查,常规检测孕前FPG,分为孕前FPG低水平组(3.9 mmol/L≤FPG<5.0 mmol/L)和孕前FPG高水平组(5.0 mmol/L≤FPG<6.1 mmol/L)。孕10～12周检测孕早期FPG值,分为孕早期FPG低水平组(3.9 mmol/L≤FPG≤4.5 mmol/L)和孕早期FPG高水平组(4.5 mmol/L相似文献   

妊娠期糖尿病筛查与诊断的进展

妊娠期糖尿病(GDM)是常见的产科并发症，其发生率为1％～13．9％。不良的妊娠结局与血糖水平相关，GDM的筛查时间应在妊娠18周前，筛查对象为普查或选择性筛查，以空腹血糖(FBG)代替糖负荷试验(GCT)，以FBG≥5．6mmol／L为阈值，进行口服糖耐量试验(OGTT)检查，能够取得理想的敏感度和特异度，诊断方法分为一步法和两步法，测血浆血糖优于测全血血糖，Carpenter标准更适用于GDM的临床诊断。     

75 g OGTT不同时间点血糖指标与妊娠期糖尿病产妇妊娠结局的关系分析

目的:研究75 g口服葡萄糖耐量试验(OGTT)不同时间点血糖指标与妊娠期糖尿病(GDM)产妇妊娠结局的关系。方法:403例GDM产妇,其75 g OGTT结果中仅1项血糖升高为A组(空腹血糖升高为A1组,1小时血糖升高为A2组,2小时血糖升高为A3组),2项血糖升高为B组(空腹及1小时血糖升高为B1组,空腹及2小时血糖升高为B2组,1小时及2小时血糖升高为B3组),3项血糖升高为C组。回顾性分析孕妇一般资料和妊娠结局。结果:A、B、C 3组孕妇甲状腺功能减退、妊娠期高血压疾病、剖宫产发生率及新生儿体质量指数(BMI)、胸围、巨大儿、早产、转入新生儿科发生率比较差异有统计学意义(P0.05),C组母儿不良结局发生率高于A、B组;A2组新生儿BMI、胸围、胎儿窘迫及剖宫产发生率高于A1和A3组(P0.05);B3组巨大儿及剖宫产发生率低于B1与B2组。结论:75 g OGTT 3项时间点血糖均升高的GDM产妇母儿不良结局增加;空腹及任何1项服糖后血糖升高时,产妇剖宫产及新生儿巨大儿发生率增加;1小时血糖升高和新生儿BMI可能有关。     

口服葡萄糖耐量试验中空腹血糖水平在妊娠期糖尿病诊断中的作用

目的 探讨妊娠24～28周间口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)中空腹血糖值在诊断妊娠期糖尿病(gestational diabetes mellitus,GDM)中的作用. 方法 对2010年1月1日至12月31日间,于首都医科大学附属北京妇产医院产前检查,妊娠早期空腹血糖正常(＜7.0 mmol/L),妊娠24～28周50 g葡萄糖负荷试验≥7.8 mmol/L并行75 g OGTT的6516例孕妇的OGTT结果进行分组分析.采用卡方检验,了解按OGTT空腹血糖水平分组后GDM的诊断情况. 结果 按国际糖尿病与妊娠研究组(International Association of Diabetes and Pregnancy Study Groups,IADPSG)的GDM诊断标准,单纯依据OGTT空腹血糖升高(≥5.1 mmol/L)可诊断15.0％(980/6516)的GDM患者,剔除这部分患者后,余OGTT空腹血糖＜5.1 mmol/L的5536例孕妇纳入分组分析.以OGTT中空腹血糖值每升高0.1 mmol/L为1个分界进行第1次分组,结果显示,随着空腹血糖水平的升高,GDM的诊断率逐渐增加(X2=282.175,P=0.000).按照空腹血糖在4.0～4.8 mmol/L间每升高0.2 mmol/L为1个分界进行第2次分组分析,显示随着空腹血糖水平的升高,各组GDM诊断率仍呈现升高趋势(X2=274.364,P=0.000).两种分组结果均显示,当OGTT中空腹血糖水平＜4.2 mmol/L(1226/5536,占22.1％)时,GDM诊断率为3.6％(44/1226),可以考虑对该部分患者暂时不行OGTT检测;当OGTT中空腹血糖水平≥4.8 mmol/L时,GDM诊断率明显增加,为26.2％(298/1138),故应提高警惕. 结论 妊娠24～28周行OGTT前建议先行空腹血糖筛查,空腹血糖≤4.2 mmol/L的低危孕妇可免于OGTT检测.     

糖化血红蛋白检测在妊娠合并糖尿病诊疗中的价值

妊娠合并糖尿病包括孕前糖尿病(PGDM)和妊娠期糖尿病(GDM),与母儿近远期并发症有关。糖化血红蛋白(HbA1c)可反映近2~3个月血糖水平,近年来用作非妊娠期糖尿病的诊断标准之一。很多学者对不同妊娠时期HbA1c水平能否预测GDM的发生、母儿不良妊娠结局和母亲产后糖尿病发生风险以及不同种族HbA1c水平差异、HbA1c水平的影响因素等方面进行了大量研究,多数认为HbA1c作为GDM的诊断指标敏感度不高,可能增加漏诊率,但其单独或与更多指标联合是筛查和诊断GDM的有力补充,可以减少口服葡萄糖耐量试验(OGTT)的检测。孕期不同时点的HbA1c水平均可能与妊娠结局有关,而产前HbA1c水平对识别可能进展为2型糖尿病的高危GDM孕妇也有一定的价值。不过,对HbA1c的截断值、包含HbA1c的不同筛查诊断策略意见尚不统一,仍需更多的研究进一步明确。     

早期预防护理对妊娠期糖尿病孕妇血糖控制及妊娠结局的影响

目的 分析早期预防护理对妊娠期糖尿病（GDM）孕妇血糖控制及妊娠结局的影响。方法 选择100例GDM孕妇为研究对象,随机分成两组,各50例。对照组实施常规护理,观察组实施早期预防护理,比较两组的血糖相关指标、妊娠结局及新生儿不良反应发生情况。结果 观察组空腹血糖、餐后2 h血糖和糖化血红蛋白水平低于对照组（P<0.05）;不良妊娠结局发生率观察组（16.00%）低于对照组（34.00%）,新生儿不良反应发生率观察组（14.00%）低于对照组（32.00%）,差异有统计学意义（P<0.05）。结论 实施早期预防护理,可有效降低妊娠期糖尿病孕妇的血糖水平,最大限度地避免不良妊娠结局和对新生儿的不利影响。     

Diagnostic of gestational diabetes mellitus and the prevalence of LGA (Large for Gestational Age)

OBJECTIVES: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance, first time detected in pregnancy. Early diagnosis of the disease may reduce fetal exposure to maternal hyperglycemia and decrease the risk of LGA. The aim of the study was to examine the influence of time and diagnostic method of GDM on the prevalence of LGA and pregnancy outcome among patients with gestational diabetes. MATERIAL AND METHODS: The study was conducted among 211 women with gestational diabetes mellitus, the patients of 1st Clinic of Obstetrics and Gynecology at the Medical University in Warsaw. We have reviewed the results of fasting plasma glucose, 50-g glucose screening test (GCT) and 2 hour 75-g glucose tolerance test in GDM patients with LGA and eutrophic newborns. The t-student or the Mann-Whitney test was used in order to compare both groups. P<0.05 was deemed statistically significant. RESULTS: LGA was diagnosed in 10.4% of patients. We did not find any significant differences in gestational age when GDM was diagnosed, results of fasting glucose GCT and OGTT among LGA (M) and control (K) group. However, when we compared the percentage of LGA in groups of women with different time of GDM diagnosis, the highest prevalence was noted in the group of first trimester diagnosis and between 28 and 32 weeks of pregnancy, which we found interesting. We compared the women and the results of the diagnostic tests with the group of standard time of GDM diagnosis (24-28 week of pregnancy) and the only difference was the late diagnosis. If 75-g glucose tolerance test had not included 1-hour after load glucose assignment, GDM would not have been diagnosed at all in 18.2% of female patients with LGA. We have not found any correlations between the results of the diagnostic tests, the time of the diagnosis or the mode of treatment GDM (diet alone or with insulin) and the birth weight. CONCLUSIONS: 1. Results of fasting glucose and glucose tolerance tests are not useful in the prediction of LGA in GDM pregnancies. 2. Diagnosis of GDM during the recommended period (between 24 and 28 weeks of pregnancy) may decrease the prevalence of LGA (comparing to later diagnostics). 3. 75-g glucose tolerance test should provide fasting, 1 and 2-hour after load glucose assignment.     

Screening of gestational diabetes mellitus: a new consensus?

The choice of thresholds to diagnose gestational diabetes mellitus (GDM) is a topic of ongoing controversy. In 2008, the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study showed continuous graded relationships between increasing maternal plasma glucose and increasing frequency of adverse perinatal outcomes. Macrosomia (birth weight>90th percentile for gestational age), primary cesarean delivery, clinical neonatal hypoglycemia and hyperinsulinemia (cord serum C peptide>90th percentile) were all related to each of the 3 glucose values (fasting plasma glucose and at 1 and 2 hours after the 75 g oral glucose test). The associations were continuous with no obvious thresholds at which risks increased. The International Association of Diabetes and Pregnancy Study Group (IADPSG) recently issued recommendations that the diagnosis of GDM be made when any of the following thresholds are met or exceeded: fasting plasma glucose: 0,92 g/L; 1 hour: 1,80 g/L; or 2 hours: 1,53 g/L after the 75 g oral glucose test. These criteria were chosen to identify pregnancy with increased risk of adverse perinatal outcomes. By the new criteria, the total incidence of gestational diabetes in the HAPO population was 17, 8%. Fasting plasma glucose (FPG) in early pregnancy appears as an important predictive factor. Higher first trimester FPG (lower than those diagnostic of diabetes) are associated with increased risks of later diagnosis of gestational diabetes and adverse pregnancy outcomes. Whether this new consensus will be adopted by public health bodies and professionals remains to be seen.     

Fasting or two-hour postprandial plasma glucose levels in early months of pregnancy as screening tools for gestational diabetes mellitus developing in later months of pregnancy

PURPOSE: The present study was done to find out whether the fasting or 2-hour postprandial plasma glucose (PPPG) levels in early months of pregnancy can be used as screening tools for gestational diabetes mellitus (GDM) developing in later months of pregnancy. BASIC PROCEDURE: Fasting and 2-hour PPPG levels were measured in the early months of pregnancy in 246 women attending the antenatal clinic of the author. All of the women underwent glucose challenge tests with 50 grams of glucose at 24-28 weeks and if the value exceeded 140 mg%, a three-hour oral glucose tolerance test (OGTT) with 100 grams of glucose was performed to diagnose GDM. MAIN FINDINGS: The present study found that the incidence of GDM was 10.5% in the third trimester. Statistical analysis did not show any correlation between fasting and the PPPG values in the early months and GDM in later months of pregnancy. CONCLUSION: Fasting or PPPG values cannot be used as efficient screening tools for GDM developing in the later months of pregnancy.     

Committee opinion no. 504: screening and diagnosis of gestational diabetes mellitus

Gestational diabetes mellitus (GDM), defined as carbohydrate intolerance that begins or is first recognized during pregnancy, is associated with increased maternal, fetal, and neonatal risks. The prevalence of GDM in the United States is increasing, probably because of increasing rates of overweight and obesity. A universal recommendation for the ideal approach for screening and diagnosis of GDM remains elusive. At this time, the Committee on Obstetric Practice continues to recommend a two-step approach to screening and diagnosis. All pregnant women should be screened for GDM, whether by patient history, clinical risk factors, or a 50-g, 1-hour glucose challenge test at 24–28 weeks of gestation. The diagnosis of GDM can be made based on the result of the 100-g, 3-hour oral glucose tolerance test, for which there is evidence that treatment improves outcome.     

Fasting capillary glucose as a screening test for gestational diabetes mellitus

Objective  To evaluate fasting capillary glucose as a screening test for gestational diabetes mellitus (GDM) compared with traditional risk factors and repeated random capillary glucose measurements.
Design  Cross-sectional, population-based study.
Setting  Maternal Health Care Clinics in Örebro County, Sweden.
Population  An unselected population of women without diabetes.
Methods  Fasting capillary glucose levels were measured at gestational weeks 28–32. Random capillary glucose levels were measured four to six times during pregnancy. Traditional risk factors for GDM were registered. GDM was diagnosed using a 75-g oral glucose tolerance test.
Main outcome measures  Sensitivity, specificity, likelihood ratios.
Results  In 55 of 3616 women participating in the study, GDM was diagnosed before 34 weeks of gestation. For fasting capillary glucose cutoff values between 4.0 and 5.0 mmol/l, sensitivity was in the range between 87 and 47% and specificity between 51 and 96%. Using a combined screening model of traditional risk factors with fasting capillary glucose at various cutoff values increased the sensitivity only slightly compared with using fasting capillary glucose alone.
Conclusion  In this Swedish, unselected, low-risk population, fasting capillary glucose measurements were found to be an acceptable and useful screening test for GDM.     

The twentieth century: The century of progress and medicine

The standard criteria for the diagnosis of gestational diabetes (GDM) is based on two abnormal values of a 3-h-100-g oral glucose tolerance test (GTT). Although a markedly elevated 1 h–50-g screen value has been suggested to support a diagnosis of GDM, limited data are available to substantiate this empiric observation. Our purpose was to examine the utility of various 50-g screen cutoff values in establishing the diagnosis of gestational diabetes.

We identified 422 gravidas with a positive 50-g screen (≥135 mg/dl) who underwent additional glucose testing. GDM was defined according to the National Diabetes Data Group (NDDG) standards for the 3-h GTT. An analysis employing the criteria of Carpenter and Coustan was performed for comparison. If a patient had an elevated 50-g value and no 3-h GTT was performed, a fasting serum glucose ≥140 mg/dl was considered evidence of gestational diabetes.

One hundred twenty four (29.4%) had GDM as defined by the NDDG criteria; this increased to 161 (38%) when the diagnosis was based on Carpenter and Coustan's criteria. The mean (≥SD) gestational age at screening was 24 ± 7 weeks. As expected, the prevalence of GDM increased in relation to an increasing 50-g value. All subjects with a 50-g screen < 216 mg/dl had evidence of gestational diabetes and required insulin for glycemic control.

Patients with a 50-g screen ≥220 mg/dl do not all require a 3-h GTT. Those with a fasting serum glucose of ≥140 mg/dl may begin diet therapy, glucose monitoring, and insulin as indicated. If the fasting serum glucose is < 140 mg/dl, a 3-h GTT should be performed for confirmation of GDM. This approach will facilitate rapid therapeutic intervention and reduce the cost of care in this subset of patients. Gravidas with a very high 50-g screen are at significant risk of requiring insulin to maintain euglycemia during pregnancy.     

妊娠期糖尿病筛查的方法及评价

妊娠期糖尿病(gestational diabetes mellitus,GDM)是影响妊娠结局的主要危险因素之一,与母儿近、远期不良妊娠结局密切相关。近年来,随着人们生活水平的提升和饮食习惯的改变,GDM的发病率呈现逐年增长的趋势,且越来越年轻化,及时筛查并给予有效的干预与治疗措施是降低GDM发病率及减少妊娠期相关并发症的关键。本文就不同的GDM的筛查策略进行综合分析,为改善母婴结局提供选择。     

Pregnancy resolutions among pregnant teens: termination,parenting or adoption?

Women with gestational diabetes mellitus (GDM) and their offsprings are at increased risk of future type 2 diabetes and metabolic abnormalities. Early diagnosis and proper management of GDM, as well as, postpartum follow-up and preventive care is expected to reduce this risk. However, no large scale prospective studies have been done particularly from the developing world on this aspect. The objective of this study is to identify and follow a cohort of pregnant women with and without GDM and their offspring to identify determinants and risk factors for GDM, for various pregnancy outcomes, as well as, for the development of future diabetes and metabolic abnormalities. This is a prospective cohort study involving pregnant women attending prenatal clinics from urban, semi-urban and rural areas in the greater Chennai region in South India. Around 9850 pregnant women will be screened for GDM. Socio-economic status, demographic data, obstetric history, delivery and birth outcomes, perinatal and postnatal complications, neonatal morbidity, maternal postpartum and offsprings follow-up data will be collected. Those diagnosed with GDM will initially be advised routine care. Those unable to reach glycaemic control with diet alone will be advised to take insulin. Postpartum screening for glucose abnormalities will be performed at months 3 and 6 and then every year for 10 years. The offsprings will be followed up every year for anthropometric measurements and growth velocity, as well as, plasma glucose, insulin and lipid profile. In addition, qualitative research will be carried out to identify barriers and facilitators for early GDM screening, treatment compliance and postpartum follow-up and testing, as well as, for continued adherence to lifestyle modifications. The study will demonstrate whether measures to improve diagnosis and care of GDM mothers followed by preventive postpartum care are possible in the routine care setting. It will also map out the barriers and facilitators for such initiatives and provide new evidence on the determinants and risk factors for both GDM development and occurrence of adverse pregnancy outcomes and development of future diabetes and metabolic abnormalities in the GDM mother and her offspring.     

Risk of diabetes mellitus after pregnancy complicated by gestational diabetes mellitus (GDM)

OBJECTIVES: The aim of the study was an assessment of glucose tolerance disorders' (GTD) prevalence after pregnancy complicated by GDM. DESIGN: Retro- and prospective clinical study. MATERIAL AND METHODS: The group of 461 women having GDM in their index pregnancies was invited to postpartum glucose metabolism assessment. Of them 192 subjects responded positively. In 47 of them the postpartum diagnosis of diabetes had already been established. The remaining 145 subjects underwent detailed testing that embraced fasting plasma glucose and whole blood HbA1c level measurement. Oral 75-g glucose tolerance test (OGTT) was also performed. RESULTS: OGTT revealed GTD in 55 subjects. Diabetes was found in 8 cases, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in 23 and 24 cases respectively. Postpartum GTD appeared in 63.3% of insulin treated subjects (GDM2) compared with 30.1% of women treated with diet only (GDM1). A group with pathological OGTT had mean HbA1c concentration significantly higher compared to the one with normal test results (6.0+/-1.7% vs. 5.1+/-0.3%; p<0.001), although HbA1c>6.0% was observed only in 23.6% women with GTD. Moreover, in 25% of subject with newly diagnosed diabetes HbA1c level did not exceeded 6.0%. CONCLUSIONS: 1. More than 50% of subjects with GDM developed diabetes or other GTD during the first 6 years postpartum. 2. Risk of postpartum GTD is significantly higher in women treated with insulin during pregnancy. 3. HbA1c measurement is less sensitive than OGTT for detection of GTD after pregnancy complicated by GDM.