Abstract：
OBJECTIVE: Our previous studies have suggested that the first trimester fasting plasma glucose (FPG) level is associated with gestational diabetes mellitus (GDM) and is a predictor of GDM. The aim of the present study was to provide valuable insights into the accuracy of the first trimester FPG level in the screening and diagnosis of GDM in southern China.
METHODS: This retrospective study included pregnant women who had their first trimester FPG level recorded at 9-13+6 weeks and underwent screening for GDM using the 2-h 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational weeks. Differences between the GDM and non-GDM groups were assessed by Student\'s t test and the chi-squared test according to the nature of the variables. A restricted cubic spine was used to explore the relationship between the first trimester FPG level and the odds ratio (OR) of GDM in pregnant women. Cut-off values of first trimester FPG were determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and 95% confidence intervals (CIs), the positive predictive value (PPV) and the negative predictive value (NPV) were calculated.
RESULTS: The medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The average first trimester FPG level was 4.62 ± 0.37 mmol/L. The OR of GDM increased with increasing first trimester FPG levels and with a value of first trimester FPG of approximately 4.6 mmol/L, which was equal to 1 (Chi-Square = 665.79, P < 0.001), and then started to increase rapidly afterwards. The ROC curve for fasting plasma glucose in the first trimester (4.735 mmol/L) for predicting gestational diabetes mellitus in pregnant women was 0.608 (95% CI: 0.598-0.617), with a sensitivity of 0.490 and a specificity of 0.676.
CONCLUSIONS: Based on the research, we recommend that all pregnant women undergo FPG testing in the first trimester, particularly at the first antenatal visit. Furthermore, we suggest that the risks of GDM should be given increased attention and management as soon as the first trimester FPG value is more than 4.7 mmol/L. First trimester FPG levels should be considered a screening marker when diagnosing GDM in pregnant women but this needs to be confirmed by more prospective studies. These factors may have a significant impact on the clinical treatment of pregnant women.
METHODS: This retrospective study included pregnant women who had their first trimester FPG level recorded at 9-13+6 weeks and underwent screening for GDM using the 2-h 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational weeks. Differences between the GDM and non-GDM groups were assessed by Student\'s t test and the chi-squared test according to the nature of the variables. A restricted cubic spine was used to explore the relationship between the first trimester FPG level and the odds ratio (OR) of GDM in pregnant women. Cut-off values of first trimester FPG were determined using receiver operating characteristic (ROC) curves and the area under the curve (AUC), and 95% confidence intervals (CIs), the positive predictive value (PPV) and the negative predictive value (NPV) were calculated.
RESULTS: The medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The average first trimester FPG level was 4.62 ± 0.37 mmol/L. The OR of GDM increased with increasing first trimester FPG levels and with a value of first trimester FPG of approximately 4.6 mmol/L, which was equal to 1 (Chi-Square = 665.79, P < 0.001), and then started to increase rapidly afterwards. The ROC curve for fasting plasma glucose in the first trimester (4.735 mmol/L) for predicting gestational diabetes mellitus in pregnant women was 0.608 (95% CI: 0.598-0.617), with a sensitivity of 0.490 and a specificity of 0.676.
CONCLUSIONS: Based on the research, we recommend that all pregnant women undergo FPG testing in the first trimester, particularly at the first antenatal visit. Furthermore, we suggest that the risks of GDM should be given increased attention and management as soon as the first trimester FPG value is more than 4.7 mmol/L. First trimester FPG levels should be considered a screening marker when diagnosing GDM in pregnant women but this needs to be confirmed by more prospective studies. These factors may have a significant impact on the clinical treatment of pregnant women.
摘要：
目的：我们先前的研究表明，孕早期空腹血糖（FPG）水平与妊娠期糖尿病（GDM）相关，并且是GDM的预测因子。本研究的目的是为中国南方地区妊娠早期FPG水平在GDM筛查和诊断中的准确性提供有价值的见解。
方法：这项回顾性研究包括在第9-13+6周记录其前三个月FPG水平的孕妇，并在第24-28孕周之间使用2小时75g口服葡萄糖耐量试验（OGTT）筛查GDM。根据变量的性质，通过学生t检验和卡方检验评估GDM和非GDM组之间的差异。使用受限的立方脊柱来探索孕妇妊娠早期FPG水平与GDM比值比（OR）之间的关系。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）确定孕早期FPG的截止值，和95%置信区间(CI)，计算阳性预测值(PPV)和阴性预测值(NPV).
结果：分析了28,030名孕妇的医疗记录，其中4,669人(16.66%)被诊断为GDM。孕早期FPG平均水平为4.62±0.37mmol/LGDM的OR随早孕期FPG水平的增加而增加，早孕期FPG值约为4.6mmol/L，等于1（卡方=665.79，P<0.001），然后开始迅速增加。孕早期空腹血糖(4.735mmol/L)预测孕妇妊娠期糖尿病的ROC曲线为0.608(95%CI:0.598-0.617),敏感性为0.490，特异性为0.676。
结论：在研究的基础上，我们建议所有孕妇在孕早期进行FPG检测，特别是在第一次产前检查。此外，我们建议，一旦孕早期FPG值超过4.7mmol/L，就应加强对GDM风险的关注和管理。在诊断孕妇GDM时，孕早期FPG水平应被视为筛查标志物，但这需要更多的前瞻性研究证实。这些因素可能对孕妇的临床治疗产生重大影响。
方法：这项回顾性研究包括在第9-13+6周记录其前三个月FPG水平的孕妇，并在第24-28孕周之间使用2小时75g口服葡萄糖耐量试验（OGTT）筛查GDM。根据变量的性质，通过学生t检验和卡方检验评估GDM和非GDM组之间的差异。使用受限的立方脊柱来探索孕妇妊娠早期FPG水平与GDM比值比（OR）之间的关系。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）确定孕早期FPG的截止值，和95%置信区间(CI)，计算阳性预测值(PPV)和阴性预测值(NPV).
结果：分析了28,030名孕妇的医疗记录，其中4,669人(16.66%)被诊断为GDM。孕早期FPG平均水平为4.62±0.37mmol/LGDM的OR随早孕期FPG水平的增加而增加，早孕期FPG值约为4.6mmol/L，等于1（卡方=665.79，P<0.001），然后开始迅速增加。孕早期空腹血糖(4.735mmol/L)预测孕妇妊娠期糖尿病的ROC曲线为0.608(95%CI:0.598-0.617),敏感性为0.490，特异性为0.676。
结论：在研究的基础上，我们建议所有孕妇在孕早期进行FPG检测，特别是在第一次产前检查。此外，我们建议，一旦孕早期FPG值超过4.7mmol/L，就应加强对GDM风险的关注和管理。在诊断孕妇GDM时，孕早期FPG水平应被视为筛查标志物，但这需要更多的前瞻性研究证实。这些因素可能对孕妇的临床治疗产生重大影响。
