Inadequacy of the risk factor based approach to detect gestational diabetes mellitus
Inadequacy of the risk factor based approach to detect gestational diabetes mellitus
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DOI：
10.4038/cmj.v57i1.4193
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发表时间：
2012-03-01
影响因子：
0.4
通讯作者：
Dissanayaka, U. T.
中科院分区：
文献类型：
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作者：
Dahanayaka, N. J.;Agampodi, S. B.;Dissanayaka, U. T.
目的评价斯里兰卡目前基于危险因素的妊娠期糖尿病（GDM）诊断方法，并与国际糖尿病与妊娠研究小组协会（IADPSG）提出的新指南进行比较。方法对阿努拉德普勒地区24 ~ 28周的孕妇进行基于社区的横断面描述性研究。从选定的保健地区的医务人员中邀请所有符合条件的孕妇参加。对所有受试者进行75 g口服葡萄糖耐量试验。结果根据IADPSG标准，36例（8.9%）孕妇患有GDM，而WHO标准为29例（7.2%）。研究人群中GDM的患病率（一种或两种方法均为阳性）为10.6% (n= 43) （95% CI 7.9-13.9%）。其中22例（51.1%）两种方法均为阳性。7名（16.3%）和14名（32.6%）母亲分别仅根据WHO和IADPSG标准呈阳性。在符合世卫组织标准的29名母亲中，只有1名空腹血糖异常，但28名2小时值异常。共有170名（42.0%）参与者至少有一种危险因素或GDM的早期指标。根据IADPSG标准，基于风险的方法只能检测到22例GDM患者，遗漏了14例（38.9%）没有任何GDM危险因素的患者。结论基于危险因素的方法漏诊超过三分之一的GDM病例。建议紧急修订现行GDM筛查指南。
Objective To evaluate the present risk factor based approach in diagnosis of gestational diabetes mellitus (GDM) in Sri Lanka in comparison with new guidelines proposed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG).Methods A community based cross sectional descriptive study was conducted among pregnant women with gestational age of 24-28 weeks and residing in Anuradhapura district. All eligible pregnant women from selected Medical Officers of Health areas were invited to participate. The 75 g oral glucose tolerance test was carried out among all participants.Results According to IADPSG criteria, 36 (8.9%) of pregnant women had GDM, compared to 29 (7.2%) according to WHO criteria. Prevalence of GDM in the study population (positive by one or both methods) was 10.6% (n= 43) (95% CI 7.9-13.9%). Of these 43 women, 22 (51.1%) had positive results by both methods. Seven (16.3%) and 14 (32.6%) mothers were positive only according to WHO and IADPSG criteria respectively. Out of 29 mothers who fulfilled WHO criteria, only one had an abnormal fasting plasma glucose, but 28 had abnormal 2 hour values. A total of 170 (42.0%) participants had at least one risk factor or early indicator of GDM. A risk based approach would have detected only 22 GDM patients according to IADPSG criteria, missing 14 cases (38.9%) who did not have any of the risk factors for GDM.Conclusions The risk factor based approach misses more than one third of GDM cases. Urgent revision of current GDM screening guidelines is recommended.