The Antepartum Glucose Values that Predict Neonatal Macrosomia Differ from Those that Predict Postpartum Prediabetes or Diabetes: Implications for the Diagnostic Criteria for Gestational Diabetes
The Antepartum Glucose Values that Predict Neonatal Macrosomia Differ from Those that Predict Postpartum Prediabetes or Diabetes: Implications for the Diagnostic Criteria for Gestational Diabetes
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DOI：
10.1210/jc.2008-2434
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发表时间：
2009-03-01
影响因子：
5.8
通讯作者：
Zinman, Bernard
中科院分区：
文献类型：
--
作者：
Retnakaran, Ravi;Qi, Ying;Zinman, Bernard
背景/目的：口服葡萄糖耐量试验（OGTT）诊断妊娠期糖尿病用于确定新生儿大于胎龄儿（LGA）和母亲产后糖尿病前期/糖尿病的风险。然而，这种做法的一个固有假设是，OGTT中定义妊娠期糖尿病的葡萄糖值与这两种结果的关系是相同的。因此，为了检验这一假设，我们试图评估每个葡萄糖值对产前OGTT的预测能力，与LGA和产后前驱糖尿病/糖尿病有关。设计/设置/参与者：共有412名妇女代表了产前葡萄糖耐量的全部谱，她们在怀孕期间接受了3小时OGTT，分娩时评估了产科结局，产后3个月接受了2小时OGTT。在产前OGTT的4个血糖值（空腹、1h、2 h、3 h）中，只有空腹测量值是LGA的显著预测因子[比值比（OR）2.00/mmol/L，95%可信区间（CI）1.20-3.34]（P = 0.0076）。相反，所有三个产后血糖值都是产后糖尿病前期/糖尿病的重要预测因子。（1小时葡萄糖：OR 1.37，95% CI 1.17-1.61，P < 0.0001; 2小时葡萄糖：OR 1.55，95% CI 1.32-1.83，P < 0.0001; 3小时葡萄糖：OR 1.37，95% CI 1.17 - 1.61，P < 0.0001; OR 1.30，95%CI 1.10-1.53，P = 0.002），而空腹血糖则无此影响。此外，空腹血糖预测LGA的受试者工作特征曲线下面积最高，（0.62），1小时和2小时血糖测量值在产后糖尿病前期/糖尿病的受试者工作特征曲线下面积最高（分别为0.68和0.72）。在产前OGTT中，空腹血糖值最能预测LGA风险，而产后血糖值预测产后前驱糖尿病/糖尿病。这些关系可能对定义产科和代谢风险的血糖阈值有影响。（临床内分泌代谢杂志94：840-845，2009）
Background/Objective: The diagnosis of gestational diabetes mellitus on oral glucose tolerance test (OGTT) is used to identify risk of both neonatal large-for-gestational-age (LGA) and maternal postpartum prediabetes/diabetes. An assumption inherent in this practice, however, is that the glucose values that define gestational diabetes mellitus on the OGTT relate to both of these outcomes in the same way. Thus, to test this assumption, we sought to evaluate the predictive capacity of each glucose value on antepartum OGTT in relation to LGA and postpartum prediabetes/diabetes.Design/Setting/Participants: A total of 412 women representing the full spectrum of antepartum glucose tolerance underwent 3-h OGTT in pregnancy, assessment of obstetrical outcome at delivery, and 2-h OGTT at 3 months postpartum.Results: Of the four glucose values (fasting, 1h, 2 h, 3 h) on antepartum OGTT, only the fasting measure was a significant predictor of LGA [ odds ratio (OR) 2.00 per mmol/liter, 95% confidence interval (CI) 1.20-3.34] (P = 0.0076). In contrast, all three postload glucose values were significant predictors of postpartum prediabetes/diabetes (1 h glucose: OR 1.37, 95% CI 1.17-1.61, P < 0.0001; 2 h glucose: OR 1.55, 95% CI 1.32-1.83, P < 0.0001; 3 h glucose: OR 1.30, 95% CI 1.10-1.53, P = 0.002), whereas fasting glucose was not. Furthermore, whereas fasting glucose had the highest area under the receiver operating characteristic curve for predicting LGA (0.62), the 1- and 2-h glucose measures had the highest area under the receiver operating characteristic curve values for postpartum prediabetes/diabetes (0.68 and 0.72, respectively).Conclusions: On antepartum OGTT, the fasting glucose value best predicts LGA risk, whereas postload glucose values predict postpartum prediabetes/diabetes. These relationships may have implications for the glycemic thresholds that define obstetrical and metabolic risk. (J Clin Endocrinol Metab 94: 840-845, 2009)