Alissa Kathleen Prior,Cara Dolin,Whitney Renee Bender,Celeste Durnwald,Rebecca F Hamm
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引用次数: 0
Abstract
OBJECTIVE
The Endocrine Society recommends a postpartum fasting blood glucose (FBG) be performed for patients with gestational diabetes mellitus (GDM) prior to hospital discharge to screen for ongoing hyperglycemia. There is limited data, however, on whether a FBG can screen for glucose intolerance and if it correlates with the gold standard 4-to-12-week 2-hour oral glucose tolerance test (OGTT). Our objective was to evaluate if FBG correlates with the gold standard 2-hour OGTT.
STUDY DESIGN
This retrospective cohort study of patients with GDM who delivered >20 weeks gestation at 2 urban centers from January 2017 to December 2020 included those who completed both a postpartum FBG prior to discharge and a 2-hour 75-gram OGTT within 1 year of delivery. Abnormal 2-hour OGTT was defined as fasting value ≥100mg/dL and/or 2-hour value ≥140mg/dL. We evaluated test characteristics (e.g. sensitivity, specificity) of postpartum FBG cutoffs at predicting an abnormal 2-hour OGTT result.
RESULTS
235 patients met inclusion criteria, of which 63% were diet-controlled and 37% required medical management. FBG ranged from 64-134mg/dL, with 6/235 (2.6%) with values ≥ 126mg/dL. 39/235 (16.6%) of patients had an abnormal 2-hour OGTT. Overall, AUC for FBG predicting abnormal 2-hour OGTT was 0.65. Traditionally considered high cutoffs (≥126mg/dL) for predicting persistent impaired glucose intolerance demonstrated poor PPV (< 20%). In contrast, low cutoffs demonstrated excellent NPV (>90%). A postpartum FBG of 88mg/dL was determined to be the optimal cutoff for FBG with NPV=92.4% (Youden index=0.34). In this dataset, if FBG ≥88mg/dL was used to determine if 2-hour OGTT was required, almost half of GDM patients could avoid further glucose tolerance testing.
CONCLUSIONS
While previously thought of as best utilized for its PPV, the FBG may be best used for its NPV. In our study, clinical application of a FBG <88mg/dL was highly correlative with a normal 2-hour OGTT.
期刊介绍:
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.