胎儿胰腺周长对妊娠糖尿病的预测能力。

IF 6.1 1区 医学 Q1 ACOUSTICS Ultrasound in Obstetrics & Gynecology Pub Date : 2024-09-01 Epub Date: 2024-08-01 DOI:10.1002/uog.27719
Y Gilboa, Y Geron, S Perlman, L Drukker, K Ofir, A Ellert, R Bardin, R Achiron, Z Kivilevitch
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引用次数: 0

摘要

目的评估在标准血液检测筛查和诊断前,胎儿胰腺大小预测母体妊娠糖尿病(GDM)的能力:这是一项回顾性队列研究,研究对象是 2017 年至 2020 年期间在以色列两家超声波单位对妊娠 20-25 周的低危孕妇进行常规二胎胎儿解剖学筛查时招募的孕妇。研究了胎儿胰岛周长≥第80和≥第90百分位数以及葡萄糖挑战试验(GCT)对GDM结果的预测性能。采用独立样本 t 检验比较有 GDM 和无 GDM 孕妇的平均胰周百分位数。用 2 × 2 或然率表和接收者操作特征曲线(ROC)评估诊断性能:共有 195 名妇女被选中进行统计分析。24名妇女(12.3%)随后被诊断为 GDM。与非 GDM 组相比,GDM 组胰腺周长的平均值(± SD)百分位数明显更高(82.4 ± 14.6 vs 62.8 ± 27.6;胰腺周长的第 3 个百分位数截断值对未来孕产妇 GDM 的敏感性(70.8%)和阳性预测值(23.3%)最高,第 75 个百分位数截断值在敏感性和特异性之间达到最佳平衡(敏感性 79%;特异性 60%)。与胰腺周长的两个临界值相比,GCT 具有更好的特异性(90.2%)和阴性预测值(97.9%)。与 GCT 相比,胰周率的 ROC 曲线下面积更高(0.71 vs 0.64),且只有前者具有统计学意义(P = 0.001):结论:与 GCT 相比,胎儿胰腺周径具有更高的阳性预测能力。结论:胎儿胰岛周径与 GCT 相比具有更高的阳性预测能力,测量胰岛周径可以识别母体 GDM 的高风险孕妇,从而促进早期诊断和治疗,减少胎儿暴露于母体高血糖水平的时间,改善婴儿的预后。© 2024 作者。妇产科超声》由 John Wiley & Sons Ltd 代表国际妇产科超声学会出版。
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Predictive capacity of fetal pancreatic circumference for gestational diabetes mellitus.

Objective: To assess the capacity of fetal pancreatic size, before standard blood glucose testing for screening and diagnosis, to predict maternal gestational diabetes mellitus (GDM).

Methods: This was a retrospective cohort study of low-risk pregnant women recruited during routine second-trimester fetal anatomical screening at 20-25 weeks' gestation at two ultrasound units in Israel between 2017 and 2020. The predictive performance of fetal pancreatic circumference ≥ 80th and ≥ 90th centiles and glucose challenge test (GCT) was examined for the outcome of GDM. The independent-samples t-test was used to compare mean pancreatic circumference centile between pregnancies with GDM and those without GDM. Diagnostic performance was evaluated with 2 × 2 contingency tables and receiver-operating-characteristics (ROC) curves.

Results: Overall, 195 women were selected for statistical analysis. Twenty-four (12.3%) women were diagnosed subsequently with GDM. The mean ± SD fetal pancreatic circumference centile was significantly higher in the GDM group compared with the non-GDM group (82.4 ± 14.6 vs 62.8 ± 27.6; P < 0.001). The pancreatic circumference centile was correlated positively with the estimated fetal weight centile (Pearson's coefficient, 0.243; P = 0.001). The 80th centile cut-off for pancreatic circumference had the highest sensitivity (70.8%) and positive predictive value (23.3%) for future maternal GDM, with the best trade-off between sensitivity and specificity achieved at the 75th centile cut-off (sensitivity, 79%; specificity, 60%). The GCT had better specificity (90.2%) and negative predictive value (97.9%) compared with both cut-offs in pancreatic circumference. The area under the ROC curve was higher for pancreatic circumference compared with GCT (0.71 vs 0.64) and only the former was statistically significant (P = 0.001).

Conclusions: Fetal pancreatic circumference has a higher positive predictive capacity compared with GCT. Measuring pancreatic circumference can identify pregnancies at high risk for maternal GDM, thereby promoting earlier diagnosis and treatment, decreasing the time period during which the fetus is exposed to high maternal glucose levels and improving infant outcome. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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