对孕妇行重复性血糖筛查必要性的研究

目的　探讨对孕妇行重复性血糖筛查的必要性及相关因素。方法　 2 0 0 1年 12月 1日至 2 0 0 2年 12月 31日 ,选取自孕早期开始在我院行产前检查并分娩的单胎、初产孕妇 714例 ,在孕中期行口服 5 0 g葡萄糖负荷试验 (GCT) ,对其中的 6 39例在孕晚期行第 2次 5 0 gGCT ;5 7例第 2次直接进行 75g葡萄糖耐量试验 (OGTT)。妊娠期糖尿病的诊断以国内董志光等的标准为准 ,并与美国糖尿病资料组 (NDDG)标准进行比较。同时对发生妊娠期糖尿病相关因素进行分析。结果　 (1)以5 0 gGCT 1h血糖≥ 7 8mmol/L为异常 :第 1次 5 0 gGCT异常 190例 ,异常率为 2 6 6 % ,正常 5 2 4例 (73 4 % ) ;第 2次 5 0 gGCT异常 2 2 5例 ,异常率为 35 2 %。 5 0gGCT异常组孕妇年龄大于正常组(P <0 0 5 ) ,而两组孕妇在家族史及体重指数 (BMI)间比较 ,差异无显著性 (P >0 0 5 )。第 2次 5 0 gGCT异常组的新生儿出生体重及巨大儿例数均比正常组明显增加 (P <0 0 5 )。 (2 )按董志光的标准 ,第 1次 5 0 gGCT筛查出妊娠期糖尿病 2 8例 ,葡萄糖耐量低减 4 0例 ;第 2次 5 0gGCT又新筛查出妊娠期糖尿病 15例 ,葡萄糖耐量低减 2 7例。按NDDG的标准 ,第 1次 5 0 gGCT筛查出妊娠期糖尿病 14例 ,葡萄糖耐量低减 2 4例 ;第 2次 5 0 g

Evaluation of the glucose screening retest during pregnancy

OBJECTIVE: To evaluate of the glucose screening retest for gestational diabetes mellitus (GDM) during pregnancy. METHODS: A retrospective analysis of 714 pregnant women screened for GDM, between December 1, 2001, and December 31, 2002, was performed. The first glucose challenge test (GCT) was performed in 16 - 27 week and retested in 28 - 38 week. Diagnosis of GDM was based on the criteria of Dong. NDDG criteria was also discussed. RESULTS: (1) 1-hour glucose value of 50 g GCT >or= 7.8 mmol/L was set as abnormal. The first 50 g GCT abnormal rate was 26.6% (190/714), and the retest abnormal rate was 35.2% (225/639). The mean age of pregnant women in 50 g GCT positive group was significantly higher than that in the negative group (P < 0.05), but there was no significant difference in family history and body mass index (BMI) between the two groups. Both the mean birth weight and the incidence of macrosomia of second 50 g GCT abnormal group were significantly higher than those in the normal group (P < 0.05). (2) By the criteria of Dong, 28 women were found to have GDM and 40 have IGT (impaired glucose tolerance) by the first 50 g GCT. New added cases included 15 GDM and 27 IGT by the retest 50 g GCT. By NDDG criteria, 14 GDM and 24 IGT cases were diagnosed by the first 50 g GCT, 5 GDM and 14 IGT cases by retest GCT. (3) The 1-hour blood glucose value [(7.3 +/- 1.6) mmol/L] in second 50 g GCT were significantly higher than those in first 50 g GCT [(6.9 +/- 1.8) mmol/L]. The results of 50 g GCT of two times were consistent in 68.1% women (normal/normal and abnormal/abnormal). There were 376 (52.7%) women whose 1-hour glucose value of the first 50 g GCT or= 7.8 mmol/L, and the 75 g OGTT should be done directly. (3) Maternal age appears to be the most important risk factor for GDM.