妊娠期糖尿病的筛查及其对妊娠的影响

目的通过对妊娠期糖尿病的筛查,了解妊娠期糖尿病的发病率,探讨妊娠期糖尿病与妊娠结局的关系,以期降低母儿并发症。方法回顾性分析本院产检行血糖筛查的3124例孕妇,诊断为妊娠期糖尿病113例,其中80例作为观察组,同期正常孕妇80例作为对照组,分析其临床经过及其对妊娠的影响。结果妊娠期糖尿病的发病率为3.62%,观察组妊娠期高血压、羊水过多、早产、巨大儿、剖宫产、产后出血、新生儿低血糖、新生儿窒息均高于对照组,差异有统计学意义(P<0.05)。结论妊娠期糖尿病的母儿并发症明显增加,对所有孕妇进行糖尿病筛查,有利于妊娠期糖尿病的早期诊断、围生期管理,从而减轻其对妊娠的影响。     

Screening and Diagnosis of Gestational Diabetes Mellitus: Critical appraisal of the new International Association of Diabetes in Pregnancy Study Group recommendations on a national level

OBJECTIVE To study the implications of implementing the International Association of Diabetes in Pregnancy Study Group (IADPSG) recommendations for screening and diagnosis of gestational diabetes mellitus (GDM) in Israel and explore alternative methods for identifying women at risk for adverse pregnancy outcomes. RESEARCH DESIGN AND METHODS We analyzed data of the Israeli Hyperglycemia and Adverse Pregnancy Outcomes study participants (N = 3,345). Adverse outcome rates were calculated and compared for women who were positive according to 1) IADPSG criteria, 2) IADPSG criteria with risk stratification, or 3) screening with BMI or fasting plasma glucose (FPG). RESULTS Adopting IADPSG recommendations would increase GDM diagnosis by ～50%. One-third of IADPSG-positive women were at low risk for adverse outcomes and could be managed less intensively. FPG ≥89 mg/dL or BMI ≥33.5 kg/m(2) at 28-32 weeks of gestation detected proportions of adverse outcomes similar to IADPSG criteria. CONCLUSIONS Implementing IADPSG recommendations will substantially increase GDM diagnosis. Risk stratification in IADPSG-positive women may reduce over-treatment. Screening with FPG or BMI may be a practical alternative.     

妊娠期糖尿病的管理与妊娠结局相关性分析

目的分析妊娠期糖尿病(GDM)的管理与妊娠结局的相关性。方法回顾性分析87例GDM患者的临床资料,根据血糖控制程度分为满意组和不满意组,对比两组孕产妇并发症率、剖宫产率及新生儿病率。结果不满意组妊高征、酮症、羊水过多、早产、胎儿发育迟缓的发生率及剖宫产率明显高于满意组,新生儿巨大儿、低血糖、呼吸窘迫综合征、畸形、新生儿窒息的发生率明显高于满意组,差异均有显著性意义(P<0.05)。结论重视围产保健,争取GDM的早期诊断和治疗,加强管理,以饮食控制为基础,必要时加用胰岛素,适当放宽剖宫产指征,有利于获得良好妊娠结局。     

不同诊断标准诊断妊娠期糖尿病与不良妊娠结局关系的探讨

目的 探讨国际糖尿病与妊娠研究组织（IADPSG）标准和美国国家糖尿病数据组（NDDG）标准诊断妊娠期糖尿病（GDM）与不良妊娠结局关系.方法 随机选择从2012年1月-2014年1月在门诊完成产检,住院分娩且临床资料完整的单胎孕妇.在孕24-28周时进行口服75 g葡萄糖耐量试验（oral glucose tolerance test,OGTT）,分别采用IADPSG及NDDG两种标准确诊为GDM患者的共323例（GDM组）,其中达到NDDG标准的为A组（174例）,达到IADPSG标准但未达到NDDG标准的为B组（149例）,另选择同期住院分娩的非GDM正常孕妇323例为对照组,分别统计分析各组新生儿高胆红素血症、新生儿低血糖、新生儿呼吸窘迫、子痫前期、胎膜早破、羊水过多及巨大儿不良结局的发生率.分别分析两组间差异有无显著统计学意义.结果 统计分析比较各组不良结局的发生率.其中,GDM组：高胆红素血症（2.8％ vs 0.6％）,新生儿低血糖（2.2％ vs o.3％）,子痫前期（1.9％ vs 0.0％）及胎膜早破率（2.2％ vs 0.0％）的发生率明显高于正常对照组,两组间差异有统计学显著性意义（χ^2=4.5-7.5,P值均＜0.05）,新生儿呼吸窘迫（2.2％ vs 0.6％）,羊水过多（1.5％ vs 0.3％）和巨大儿（3.1％vs 1.2％）的发生率高于对照组,但两组间差异无统计学意义（（χ^2=2.6-2.9,P值均＞0.05）;A组：新生儿高胆红素血症（2.9％vs 2.7％）,新生儿低血糖（2.3％ vs 2.0％）,新生儿呼吸窘迫（2.3％vs 2.0％）,痫前期（2.3％vs 1.3％）,胎膜早破（1.7％vs 0.7％）,羊水过多（1.7％vs 1.3％）及巨大儿（3.4％vs 2.7％）的发生率均高于B组,但两组间差异无统计学显著性意义（χ^2=0.01-0.80,P值均＞0.05）.结论 IADPSG诊断标准的敏感度比NDDG标准高,将达不到NDDG标准的轻型GDM患者纳入妊娠期血糖管理中,有效地降低其不良妊娠结局的发生率.     

妊娠期糖尿病的孕期管理与妊娠结局的分析

目的　探讨妊娠期糖尿病(GDM)孕期管理与妊娠结局的关系。方法　比较妊娠期糖尿病孕妇82例与正常对照组82例的妊娠结局,包括孕产妇并发症、剖宫产率、早产率、胎儿生长迟缓(FGR)、巨大儿发生率、围产儿死亡率及新生儿病率等。82例GDM孕妇中包括经治疗者67例和未经治疗者15例。结果　GDM组的孕产妇并发症、围产儿死亡率及新生儿病率与正常对照组相比无差异,剖宫产率、早产率、巨大儿发生率与正常对照组相比有差异,尤其未经系统治疗者发生率高。结论　GDM孕妇经过及时诊断,加强管理,用饮食疗法或胰岛素治疗有效控制血糖,适时终止妊娠,可有效降低母婴并发症的发生。     

Association of Maternal Folate and Vitamin B12 in Early Pregnancy With Gestational Diabetes Mellitus: A Prospective Cohort Study

OBJECTIVETo investigate the association of folate and vitamin B₁₂ in early pregnancy with gestational diabetes mellitus (GDM) risk.RESEARCH DESIGN AND METHODSThe data of this study were from a subcohort within the Shanghai Preconception Cohort Study. We included pregnancies with red blood cell (RBC) folate and vitamin B₁₂ measurements at recruitment (between 9 and 13 gestational weeks) and those with three samples available for glucose measurements under an oral glucose tolerance test. GDM was diagnosed between 24 and 28 weeks’ gestation. Odds ratio (OR) and 95% CI of having GDM was used to quantify the association.RESULTSA total of 1,058 pregnant women were included, and GDM occurred in 180 (17.01%). RBC folate and vitamin B₁₂ were significantly higher in pregnancies with GDM than those without GDM (P values were 0.045 and 0.002, respectively) and positively correlated with 1-h and 2-h serum glucose. Daily folic acid supplementation in early pregnancy increases the risk of GDM; OR (95% CI) was 1.73 (1.19–2.53) (P = 0.004). Compared with RBC folate <400 ng/mL, pregnancies with RBC folate ≥600 ng/mL were associated with ∼1.60-fold higher odds of GDM; the adjusted OR (95% CI) was 1.58 (1.03–2.41) (P = 0.033). A significant trend of risk effect on GDM risk across categories of RBC folate was observed (P_trend = 0.021). Vitamin B₁₂ was significantly associated with GDM risk (OR 1.14 per 100 pg/mL; P = 0.002). No significant association of serum folate and percentile ratio of RBC folate/vitamin B₁₂ with GDM was observed.CONCLUSIONSHigher maternal RBC folate and vitamin B₁₂ levels in early pregnancy are significantly associated with GDM risk, while the balance of folate/vitamin B₁₂ is not significantly associated with GDM.     

Physical Activity Before and During Pregnancy and Risk of Gestational Diabetes Mellitus: A meta-analysis

OBJECTIVE

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and is associated with a substantially elevated risk of adverse health outcomes for both mothers and offspring. Physical activity may contribute to the prevention of GDM and thus is crucial for dissecting the vicious circle involving GDM, childhood obesity, and adulthood obesity, and diabetes. Therefore, we aimed to systematically review and synthesize the current evidence on the relation between physical activity and the development of GDM.

RESEARCH DESIGN AND METHODS

Medline, EMBASE, and Cochrane Reviews were searched from inception to 31 March 2010. Studies assessing the relationship between physical activity and subsequent development of GDM were included. Characteristics including study design, country, GDM diagnostic criteria, ascertainment of physical activity, timing of exposure (prepregnancy or early pregnancy), adjusted relative risks, CIs, and statistical methods were extracted independently by two reviewers.

RESULTS

Our search identified seven prepregnancy and five early pregnancy studies, including five prospective cohorts, two retrospective case-control studies, and two cross-sectional study designs. Prepregnancy physical activity was assessed in 34,929 total participants, which included 2,813 cases of GDM, giving a pooled odds ratio (OR) of 0.45 (95% CI 0.28–0.75) when the highest versus lowest categories were compared. Exercise in early pregnancy was assessed in 4,401 total participants, which included 361 cases of GDM, and was also significantly protective (0.76 [95% CI 0.70–0.83]).

CONCLUSIONS

Higher levels of physical activity before pregnancy or in early pregnancy are associated with a significantly lower risk of developing GDM.Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy, affecting ∼7% of all pregnancies in the U.S. (i.e., >200,000 cases annually) (1), and this number is increasing as the prevalence of obesity among women at reproductive age escalates (2–4). GDM is associated with a significantly elevated risk for short-term and long-term complications for both mothers and offspring. Women with GDM have an increased risk for perinatal morbidity and impaired glucose tolerance and type 2 diabetes in the years after pregnancy (5,6). Children of women with GDM are more likely to be obese and have impaired glucose tolerance and diabetes in childhood and early adulthood (1). In a recent meta-analysis of randomized trials on the effect of treatment for GDM, various interventions for blood glucose control, including diet, glucose monitoring, insulin use, and pharmaceutical interventions, did not significantly reduce the risk for adverse perinatal and neonatal end points, including cesarean section and perinatal or neonatal death (7). Collectively, these data indicate that prevention of GDM altogether could be crucial for avoiding its associated adverse health outcomes.Physical activity has long been known for its role in improving glucose homeostasis through its direct or indirect impact on insulin sensitivity via several mechanisms. For instance, physical activity has independent effects on glucose disposal by increasing both insulin-mediated and non–insulin-mediated glucose disposal (8,9). Physical activity can also exert long-term effects on improvement in insulin sensitivity through increased fat-free mass (10). Furthermore, the benefits of preventing or delaying the onset of type 2 diabetes among nonpregnant individuals have been reported repeatedly (11,12). Therefore, physical activity may have the potential for preventing GDM and related adverse health outcomes. However, evidence for its impact on GDM has not been systematically synthesized. The aim of this systematic review and meta-analysis was to assemble the current evidence for the relationship between physical activity and the development of GDM.     

不同糖化血红蛋白控制水平对妊娠糖尿病妊娠结局的影响分析

目的 探讨不同糖化血红蛋白控制水平对妊娠糖尿病妊娠结局的影响.方法 选取深圳市人民医院2008～2009年住院分娩妊娠糖尿病患者136例,以糖化血红蛋白≥6.0%为A组,<6.0%为B组,比较两组的空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胰岛素(FINS)、稳态模式法的胰岛素抵抗指数(HOMA-IR)以及妊娠结局的差异.结果 A组的FBG,TC,TG,LDL-C,FINS,HOMA-IR均高于B组,差异有统计学意义.除胎膜早破和巨大儿两者差异不明显外,A组的妊高征、羊水过多、剖宫产、新生儿窒息、高胆红素血症均显著高于B组.HbA1c与FPG显著正相关,相关系数为0.912 (P<0.05).结论 GDM患者的HbA1c水平与妊娠结局相关.     

Exercise and the Prevention of Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is associated with pregnancy complications and fetal complications, as well as long-term health consequences for women and their offspring. Pregnancy is a pseudodiabetogenic state of increasing insulin resistance and decreasing insulin sensitivity, which places a woman at increased risk for GDM. Exercise facilitates the uptake of blood glucose into cells to be used for energy, making exercise a potential strategy in preventing GDM. Extensive evidence has found an association between consistent moderate to vigorous exercise in pregnancy and the prevention of GDM. With close attention to risk factors, maternity care nurses and other health care providers can play an important role in educating pregnant women on exercise recommendations to help them achieve optimal health and wellness.     

胰岛素治疗对妊娠期合并糖尿病患者妊娠结局的影响

目的探讨胰岛素治疗对妊娠期合并糖尿病患者妊娠结局的影响。方法:选取2013年10月~2015年5月我院确诊治疗的妊娠期合并糖尿病患者80例,依据随机分配原则分为胰岛双胍组和二甲双胍组,每组40例,二甲双胍组患者给予二甲双胍口服治疗,胰岛双胍组在此基础上给予胰岛素皮下注射治疗,采用新生儿窒息评分(Apgar)评估新生儿窒息情况,统计分析所有患者治疗前后空腹和餐后2h血糖及妊娠结局情况。结果:治疗前,胰岛双胍组和二甲双胍组患者空腹和餐后2h血糖基本相同,无显著差异性(P0.05),但前者治疗后空腹和餐后2h血糖明显低于后者,差异有统计学意义(P0.05);胰岛双胍组患者剖宫产率、巨大儿发生率明显低于二甲双胍组,前者Apgar得分明显高于后者,差异有统计学意义(P0.05)。结论胰岛素治疗可有效控制妊娠期合并糖尿病患者的血糖水平,有利于改善患者妊娠结局,值得临床作进一步推广。     

Pregravid Liver Enzyme Levels and Risk of Gestational Diabetes Mellitus During a Subsequent Pregnancy

OBJECTIVE

Liver enzymes are independent predictors of type 2 diabetes. Although liver fat content correlates with features of insulin resistance, a risk factor for developing gestational diabetes mellitus (GDM), the relationship between liver enzymes and GDM is unclear. The objective of this study was to assess whether pregravid liver enzyme levels are associated with subsequent risk of GDM.

RESEARCH DESIGN AND METHODS

A nested case-control study was conducted among women who participated in the Kaiser Permanente Northern California multiphasic health checkup (1984–1996) and had a subsequent pregnancy (1984–2009). Case patients were 256 women who developed GDM. Two control subjects were selected for each case patient and matched for year of blood draw, age at examination, age at pregnancy, and number of intervening pregnancies.

RESULTS

Being in the highest quartile versus the lowest quartile of γ-glutamyl transferase (GGT) levels was associated with a twofold increased risk of subsequent GDM (odds ratio 1.97 [95% CI 1.14–3.42]), after adjusting for race/ethnicity, prepregnancy BMI, family history of diabetes, and alcohol use. This result was attenuated after adjusting for homeostasis model assessment of insulin resistance (HOMA-IR), fasting status, and rate of gestational weight gain. There was significant interaction between GGT and HOMA-IR; the association with GGT was found among women in the highest tertile of HOMA-IR. Aspartate aminotransferase and alanine aminotransferase were not associated with increased GDM risk.

CONCLUSIONS

Pregravid GGT level, but not alanine aminotransferase or aspartate aminotransferase level, predicted the subsequent risk of GDM. Markers of liver fat accumulation, such as GGT level, are present years before pregnancy and may help to identify women at increased risk for subsequent GDM.     

妊娠期糖尿病的筛查与处理

目的探讨妊娠期糖尿病(GDM)的诊断及处理方法。方法对2311例孕妇行葡萄糖筛查,诊断GDM57例作为观察组,选取同期符合GDM诊断标准未经正规治疗的49例作为对照组,比较两组的母儿结局。结果观察组羊水过多、巨大儿、高胆红素血症、新生儿呼吸窘迫综合征、围生儿死亡率等均明显低于对照组,差异有显著性(P<0.05)。结论及早诊断、积极治疗,可改善母儿预后。     

Exercise During the First Trimester of Pregnancy and the Risks of Abnormal Screening and Gestational Diabetes Mellitus

OBJECTIVETo estimate the effects of exercise during the first trimester on the risks of abnormal screening and gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODSData come from PETALS, a prospectively followed pregnancy cohort (n = 2,246, 79% minorities) receiving care at Kaiser Permanente Northern California. A Pregnancy Physical Activity Questionnaire was used to assess exercise. Glucose testing results for screening and diagnostic tests were obtained from electronic health records. Inverse probability of treatment weighting and targeted maximum likelihood with data-adaptive estimation (machine learning) of propensity scores and outcome regressions were used to obtain causal risk differences adjusted for potential confounders, including prepregnancy BMI, exercise before pregnancy, and gestational weight gain. Exercise was dichotomized at 1) the cohort’s 75th percentile for moderate- to vigorous-intensity exercise (≥13.2 MET-h per week or ≥264 min per week of moderate exercise), 2) current recommendations (≥7.5 MET-h per week or ≥150 min per week of moderate exercise), and 3) any vigorous exercise.RESULTSOverall, 24.3% and 6.5% had abnormal screening and GDM, respectively. Exercise meeting or exceeding the 75th percentile decreased the risks of abnormal screening and GDM by 4.8 (95% CI 1.1, 8.5) and 2.1 (0.2, 4.1) fewer cases per 100, respectively, in adjusted analyses.CONCLUSIONSExercise reduces the risks of abnormal screening and GDM, but the amount needed to achieve these risk reductions is likely higher than current recommendations. Future interventions may consider promoting ≥38 min per day of moderate-intensity exercise to prevent GDM.     

妊娠期糖尿病早期防治对产妇妊娠结局的影响分析

目的研究妊娠期糖尿病早期防治对产妇妊娠结局的影响。方法选取2014年1月~2015年1月我院收治的123例妊娠期糖尿病患者,依照数字表法随机分为观察组61例和对照组62例。对照组进行常规治疗,观察组在常规治疗的基础上进行糖尿病早期防治,观察两组产妇的妊娠结局。结果观察组血糖、血红蛋白、胆固醇等指标显著低于对照组,并发症显著少于对照粗,差异有统计学意义(P0.05);观察组巨大儿、死胎、胎儿窘迫、胎儿畸形、高胆红素症等症状显著少于对照组,差异有统计学意义(P0.05)。结论对妊娠期糖尿病患者进行早期防治,能有效控制孕期的血糖,避免不良的妊娠结局的出现。     

孕期营养指导对妊娠期糖尿病患者母婴结局的影响

目的探索孕期营养指导对于妊娠期糖尿病患者母婴结局的影响。方法选取我院2015年10月~2016年12月收治的400例妊娠期糖尿病患者。两组患者接受常规治疗,根据孕期管理方法的不同分入到观察组和对照组中,对照组患者给予常规孕期管理,观察组患者给予孕期营养指导,对比分析两组产妇并发症发生率、新生儿并发症发生率。结果观察组孕妇的并发症发生率(胎膜早破、羊水过多、产褥期感染)以及新生儿并发症发生率(巨大儿、新生儿窒息、新生儿低血糖、新生儿呼吸窘迫综合症)均比对照组更低,差异有统计学意义(P<0.05)。结论孕期营养指导用于妊娠期糖尿病患者有助于改善母婴结局,具有临床推广应用价值。     

孕早期脂代谢异常对妊娠期糖尿病发病率的影响

[目的]孕早期脂代谢异常对妊娠期糖尿病(GDM)发病率的影响.[方法]选取120例孕早期脂代谢异常的孕妇为观察组,另选120例孕早期脂代谢正常的孕妇为对照组.检测两组血清脂代谢指标:胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)以及脂肪细胞因子:瘦素、游离脂肪酸;血糖及胰岛素抵抗指标:空腹血糖(FBG)、糖化血红蛋白(HbAlc)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)水平.分析TG、瘦素与血糖及胰岛素抵抗指标的相关性,并统计两组GDM发生率、妊娠结局、胎儿及相关并发症发生情况.[结果]观察组孕妇TG、TC、LDL-C、瘦素、游离脂肪酸水平明显高于对照组,HDL-C水平明显低于对照组(P<0.05);观察组血糖指标FBG、HbAlc、HOMA-IR高于对照组,胰岛素抵抗指标FINS低于对照组(P<0.05).单因素相关分析显示TG、瘦素水平均与FBG、HbAlc、HOMA-IR呈正相关,与FINS呈负相关(P<0.05).观察组GDM发生率为35.00%,显著高于对照组16.67%(P<0.05);与对照组相比,观察组剖宫产率明显增高(P<0.05),观察组分娩后胎儿窘迫、巨大儿发生率明显增高(P<0.05).     

Early Prediction of Gestational Diabetes Mellitus in Vietnam: Clinical impact of currently recommended diagnostic criteria

OBJECTIVE

We aimed to compare the discriminative power of prognostic models for early prediction of women at risk for the development of gestational diabetes mellitus (GDM) using four currently recommended diagnostic criteria based on the 75-g oral glucose tolerance test (OGTT). We also described the potential effect of application of the models into clinical practice.

RESEARCH DESIGN AND METHODS

A prospective cross-sectional study of 2,772 pregnant women was conducted at a referral maternity center in Vietnam. GDM was determined by the American Diabetes Association (ADA), International Association of the Diabetes and Pregnancy Study Groups (IADPSG), Australasian Diabetes in Pregnancy Society (ADIPS), and World Health Organization (WHO) criteria. Prognostic models were developed using the Bayesian model averaging approach, and discriminative power was assessed by area under the curve. Different thresholds of predicted risk of developing GDM were applied to describe the clinical impact of the diagnostic criteria.

RESULTS

The magnitude of GDM varied substantially by the diagnostic criteria: 5.9% (ADA), 20.4% (IADPSG), 20.8% (ADIPS), and 24.3% (WHO). The ADA prognostic model, consisting of age and BMI at booking, had the best discriminative power (area under the curve of 0.71) and the most favorable cost-effective ratio if implemented in clinical practice. Selective screening of women for GDM using the ADA model with a risk threshold of 3% gave 93% sensitivity for identification of women with GDM with a 27% reduction in the number of OGTTs required.

CONCLUSIONS

A simple prognostic model using age and BMI at booking could be used for selective screening of GDM in Vietnam and in other low- and middle-income settings.Gestational diabetes mellitus (GDM) has increased worldwide (1) and occurs in 1–28% of all pregnancies (2). This figure varies substantially between populations and the diagnostic criteria used. GDM is associated with adverse perinatal outcomes (3), future development of type 2 diabetes in the mother (4), and an increased risk of the offspring developing obesity and impaired glucose tolerance in childhood and early adulthood (5,6). Despite the recent publication of screening guidelines based on perinatal outcomes from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) multinational large study, no international consensus for the screening of GDM has been reached (2).The 75-g oral glucose tolerance test (OGTT) is accepted as the method of screening for GDM by the American Diabetes Association (ADA) (7), the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) (8), World Health Organization (WHO) (9), and Australasian Diabetes in Pregnancy Society (ADIPS) (10). There has long been a debate about whether selective or universal screening for GDM should be performed. A universal approach to screening detects more women with GDM but requires greater resources (11,12). In low- and middle-income countries, universal screening poses particular challenges. High prevalence and limited resources available for management and health promotion may render universal screening impossible in under-resourced settings. Under these circumstances, a selective approach may be a reasonable alternative (13,14). Selective screening in women at high-risk for GDM can also result in a substantial decrease in the number of OGTTs performed compared with a universal screening, with acceptable sensitivity in case detection (14,15). Importantly, improved performance with a selective approach has been reported if the risk indicators are derived from the population where screening is being carried out (13–15). Unfortunately, which selective screening approach has the most favorable cost-effective profile if implemented in daily clinical practice has yet to be determined. These data are crucial in low- and middle-income countries where health care centers are overcrowded, understaffed, and insufficiently resourced.This study aims to determine the sensitivity and specificity of prognostic models for the selective screening of GDM in a low-resource setting. We compare four major diagnostic criteria that use the 75-g OGTT at 28 weeks’ gestation for diagnosis of GDM. We report the ability of different predictive models to identify GDM cases and the potential for reduction in the number of OGTTs needed. Using this information, we aim to determine the optimum selective screening model and diagnostic criteria for this setting.     

Postpartum Diabetes Screening: Adherence rate and the performance of fasting plasma glucose versus oral glucose tolerance test

OBJECTIVE

To determine the rate of adherence to postpartum glycemic testing in women with gestational diabetes mellitus (GDM) and the performance of fasting plasma glucose (FPG) versus the 75-g oral glucose tolerance test (OGTT) in detecting postpartum glucose intolerance.

RESEARCH DESIGN AND METHODS

The study was a retrospective cohort of 1,006 women with GDM attending a pregnancy diabetes clinic.

RESULTS

Postpartum screening was completed in 438 (48%) women. Women nonadherent to testing had higher parity (1.10 vs. 0.87) and were less likely to require insulin for management of their GDM. Among women who were tested, 89 (21%) had an abnormal result, only 25 (28%) of whom were identified by FPG. Factors associated with abnormal postpartum diabetes screening include non-Caucasian ethnicity, previous GDM, higher A1C, and OGTT values during pregnancy and treatment with insulin.

CONCLUSIONS

The rate of postpartum diabetes screening is low, and FPG lacks sensitivity as a screening test in comparison with OGTT.Gestational diabetes mellitus (GDM) strongly predicts future development of type 2 diabetes (1), and abnormal glucose tolerance can persist postpartum leading to impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and type 2 diabetes (2). Compared with an oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) has greater reproducibility but may lack sensitivity to identify women with IGT or type 2 diabetes (3–5). The main study objectives were to assess adherence with postpartum testing, to identify factors associated with nonadherence, and to compare the sensitivity of FPG versus a 75-g OGTT in detecting postpartum glucose intolerance.