- 會議論文
- OpenAccess
Evaluation of One-Step and Two-Step Oral Glucose Tolerance Test in Screening Gestational Diabetes Mellitus (online)
摘要
INTRODUCTION:Gestational Diabetes Mellitus (GDM) may increase the risks of preeclampsia, gestational hypertension, premature birth and fetal death in pregnant women. Due to very few symptoms observed, GDM screening test is recommended at 24 to 28 weeks’ gestation for general pregnant women. Oral Glucose Tolerance Test (OGTT) is an important index in diagnosing GDM. One-step OGTT: After fasting for 8 hours, administer 75g glucose orally. Two-step OGTT: Without fasting, 50g glucose is administered orally. If the blood sugar in one hour is greater or equal to 130mg/dL but less than 140mg/dL, the second step is followed, where 100g glucose is administered orally after 8-hour fasting. Both the American Diabetes Association and World Health Organization recommend One-step screening test, while the American College of Obstetricians and gynecologists support the Two-step screening test. Currently there is no consensus reached. OBJECTIVE:To explore the efficacy of One-step and Two-step OGTT screening in diagnosing gestational diabetes mellitus. METHODS:Based on the steps of evidenced-based practices, the clinical answerable questions using PICO were formed by using both Chinese and English keywords and synonyms searched in the MeSH database. The search techniques utilized were Boolean logic, which allowed for combining free-text term and controlled vocabulary term and connecting with OR; and further, PICO elements were searched and connected with AND, until July, 2022. The published studies that were available in PubMed, Cochrane library, Clinical Key and Airiti Library were investigated. Two studies were eligible for inclusion. The Critical Appraisal Skills Programme (CASP) was used for literature review. These two were with levels of evidence of 2 by the evaluation of Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. RESULTS:Pregnant women in 24-28 weeks’ gestation were the criteria of enrollment in these two studies, and were randomly divided for One-step and Two-step screening tests. The first study Hillier (2021) revealed One-step validity of 16.5% and Two-step of 8.5% in screening GDM. One-step screening showed significance in diagnosing GDM comparing to Two-step test RR1.94 (95%CI 1.79-2.11). The second study Khalifeh (2018) revealed One-step validity of 8.1% and Two-step of 5.6%, which showed no significance on both approaches (p=0.42). Hence there was no significance on One-step or Two-step screening in relation to the ratio of preeclampsia, gestational hypertension, Caesarian section due to overweight fetus, shoulder dystocia or birth-related injury (p>0.05). CONCLUSION:One-step screening test in diagnosing GDM has higher ratio than Two-step test, but both approaches have the same risks in pregnancy and childbirth. Taiwan Association of Gestational Diabetes Mellitus Care recommend One-step screening test in order to have a loose standard, and suggest aggressive health education in diet control and treatment for reducing complications at late pregnancy. By doing so, however, also increases the emotional burden in pregnant women. Therefore support and care must be provided at a timely manner.