早期妊娠糖尿病之篩檢:年紀與空腹血糖的角色

目標:隨著糖尿病發生年紀的提早以及台灣地區婦女生育年齡的延後，妊娠糖尿病的發生率節節上升。妊娠糖尿病的致病機轉是由於懷孕期間過高的血糖通過胎盤影響胎兒，因此將會增加巨嬰症、新生兒黃疸、新生兒低血糖、早產的比例及新生兒加護病房住院率，因此目前有許多標準的制定都在致力於找出並定義妊娠糖尿病。國際妊娠糖尿病研究小組於2010年發表了妊娠糖尿病的篩檢的標準，是在懷孕24-28周的時期空腹喝75克的糖水，並制定了空腹血糖，喝糖水後第一個小時及第二個小時的血糖值做為篩檢標準，美國糖尿病學會也於2011年實施該篩檢，更建議孕婦於初次產檢時，具糖尿病危險因子者須接受檢查以診斷或排除懷孕前就已罹患糖尿病。75克的糖水篩檢繁雜，後續有相當多的研究都致力於找出只要用空腹血糖就可以篩檢出糖尿病的方法，之前有研究指出懷孕24-28周的時期空腹血糖就可以篩檢出糖尿病的方法，但此法需等空腹血糖值的結果來決定是否要繼續做喝糖水的測試，因此本研究預期利用第一孕期的空腹血糖作為基準預測妊娠糖尿病。方法:本研究假設利用第一孕期的空腹血糖作為基準加上母親的年紀，即可精準的預測妊娠糖尿病。我們於2013年至2018年之間針對在台大醫院產檢的孕婦進行一項前瞻性的世代研究。妊娠糖尿病的診斷標準根據國際妊娠糖尿病研究小組所制定。結果: 加入研究的1065位病患之中，547位有完整的第一孕期血糖、妊娠24-28 週口服葡萄糖耐量試驗(Oral glucose tolerance test, OGTT)結果與生產記錄。其中妊娠糖尿病的發生率約為17.9%，此研究族群女性平均懷孕年齡為33.9歲，有將近一半的女性年齡在35歲以上，其中妊娠糖尿病的發生率也顯著隨著年齡上升而增加，本研究的”第一次產檢空腹血糖”的模式切點落在80時，可成功預測之後發生糖尿病的機會，在敏感度在90%及特異性為100%的情況下，可減少約40%需要OGTT檢測的比例，，若模式為”第一次產檢空腹血糖加上年齡”，且切點落在115時，在敏感度在90%及特異性為100%的情況下，可成功減少將近一半須要OGTT的比例。結論:本研究顯示利用第一孕期的空腹血糖作為基準加上母親的年紀，可有效預測之後發生妊娠糖尿病的機會並且降低許多不必要的OGTT檢測。

關鍵字

妊娠期糖尿病；第一孕期篩檢；空腹血糖；年紀；糖水檢測

並列摘要

AIM- The addition of maternal age to fasting plasma glucose (FPG) at 24-28 weeks of gestation can improve the performance of GDM screening as maternal age increases. However, this screening method delays the diagnosis of GDM. Since FPG is recommended as a screening test at the first prenatal visit (FPV) for pre-existing diabetes, we evaluated the performance of age plus FPG at the FPV to reduce the need for the OGTT at 24–28 weeks. METHODS- Consecutive 547 pregnant women were screened for Gestational diabetes mellitus at their FPV soon after diagnosis of pregnancy during the study period of January 2013 to June 2018. GDM was diagnosed using IADPSG criteria. RESULTS- In our study, the mean gestational age of early screen was 10 weeks. The women in our cohort were older, nearly half of them were over 35 years old. The prevalence of GDM increased with age. Both age and FPG at the FPV were independent predictors for GDM in the adjusted model (OR 1.1, 95% CI 1.03-1.18 for age, and OR 1.2, 95% CI 1.17–1.31 for FPG). The addition of age to FPG at the FPV in the screening algorithm, "age plus FPG algorithm", could reduce the use of the OGTT (OGTT %) from 62.8% to 52.8%, while maintaining a sensitivity ≥90% and a specificity of 100%, compared with using FPG alone. The optimal cut-off value for age plus FPG at the FPV is 115. CONCLUSIONS- The screening algorithm using maternal age plus FPG at the FPV can greatly simplify the IADPSG diagnostic algorithm and reduce OGTT %, especially in populations with a significant proportion of women who become pregnant at old ages.

並列關鍵字

early screen ； gestational diabetes ； age ； OGTT

參考文獻

1. 1998. Proceedings of the 4th International Workshop-Conference on Gestational Diabetes Mellitus. Chicago, Illinois, USA. 14-16 March 1997. Diabetes Care 21 Suppl 2: B1-167.

Google Scholar

2. 2014. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract 103: 341-363.

Google Scholar

3. AGARWAL MM, DHATT GS AND SHAH SM. 2010. Gestational diabetes mellitus: simplifying the international association of diabetes and pregnancy diagnostic algorithm using fasting plasma glucose. Diabetes Care 33: 2018-2020.

Google Scholar

4. AMERICAN DIABETES A. 2003. Gestational diabetes mellitus. Diabetes Care 26 Suppl 1: S103-105.

Google Scholar

5. AMERICAN DIABETES A. 2017. 2. Classification and Diagnosis of Diabetes. Diabetes Care 40: S11-S24.

Google Scholar

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早期妊娠糖尿病之篩檢:年紀與空腹血糖的角色

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