Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi

Gazi Yıldırım; Canan Yılmaz; Fırat Ersan; Rukset Attar; Aslı Somunkıran; Narter Yeşildağlar; Ateş Karateke; D. Cem Fıçıcıoğlu

doi:10.16948/zktb.91307

A retrospective analysis of the results of 100 gr oral glucose tolerans test among the pregnant patients whose 50 gr glucose challenge test were positive

Yıl 2010, Cilt: 41 Sayı: 3, 123 - 127, 01.04.2010

Gazi Yıldırım Canan Yılmaz Fırat Ersan Rukset Attar Aslı Somunkıran Narter Yeşildağlar Ateş Karateke D. Cem Fıçıcıoğlu

Öz

Objective: To determine a cut-off value on the 50 gr glucose challenge test (GCT) for the diagnosis of gestational diabetes mellitus (GDM). Materials and Methods: Ninety five pregnant patients whose 50 gr GCT are positive were included in this retrospective trial. OGTT was administered after one week to these patients. The findings were evaluated based on the test results. Results: Fifty eigth of ninety five patients (61.1%) patients got GDM diagnosis according to their OGTT results. Thirty seven of this ninety five (38.9%) patients were accepted as a normal based on OGTT results. In normal group , the mean of the GCT results was 155.8±9.3 mg/dl, in GDM group, the mean of the GCT results was 165.8±14.7 mg/dl (p=0.001). If the level of 140 mg/dl was accepted as a cut-off value for the diagnosis of GDM, sensitivity was 86% and spesifity was 19%. But when the cut-off level increased to 200 mg/dl, sensitivity decreased to 5%, spesifity increased to 100%. Conclusion: Diagnosis of GDM cannot be made just only with a certain cut-off level on GCT. Currently, it looks that two step evaluation with GCT and OGTT is most suitable and acceptable way to determine GDM in pregnancy.

Anahtar Kelimeler

Kaynakça

1. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol 2007;50(4):938-948
2. American Diabetes Assosiation: Gestational diabetes mellitus (Position Statement). Diabetes Care 2004;27 (Suppl. 1):S88-S90
3. Karcaaltincaba D, Kandemir O, Yalvaç S, Guvendag-Guven S, Haber al A. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria. Int J Gynaecol Obstet. 2009; 106:246-249
4. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins - Obstetrics. Clinical Management Guidelinesfor Obstetricians- Gynecologists. ACOG Practice Bulletin No. 30. Washington, DC: ACOG, 2001
5. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the US Preventive Services Task Force. Obstet Gynecol 2003,101: 380-92
6. Lanni SM, Barrett DP. The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a highrisk population. The Journal of Maternal-Fetal and Neonatal Medicine 2004;15:375-379
7. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144(7):768-73
8. Moore TR. Diabetes in pregnancy. In Creasy R, ResnickR, eds. Maternal Fetal Medicine, 4th edn. Philadelphia, PA: WB Saunders Company, 1999:964-95
9. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee, Diabetes Care 1998;21(Suppl. 2):B161-B167
10. American College of Obstetricians and Gynecologists: Diabetes and Pregnancy, Technical Bulletin No. 200, December 1994
11. Hanna FWF, Peters JR. Screening for gestational diabetes; past, present and future. Diabetic Med 2002; 19:351-358
12. Davidson MB. Counterpoint: the oral glucose tolerance test is superfluous. Diabetes Care2002;25:1883-1885
13. Tuomilehto J. Point: a glucose tolerance test is important for clinical practice. Diabetes Care 2002; 25:1880-1882
14. Agarwal MM, Punnose J, Dhatt GS (2004) Gestational diabetes: problems associated with the oral glucose tolerance lest. Diabetes Res Clin Pract63:73-74
15. Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Cutoff value of 1 h, 50 g glucose challenge testfor screening of gestational diabetes mellitus in a Japanese population. Diabet Research Clin Pract 2003;60:63-67
16. Jang HJ, Cho NH, Jung KB, Oh KS, Dooley SL, Metzger BL. Screening for gestational diabetes mellitus in Korea. Int J Gynaecol Obstet 1995;51:115-122
17. Yalcin HR, Zorlu CG. Threshold value of glucose screening tests in pregnancy: could it be standardizedfor every population? Am J Perinatol 1996,1996:13:317-320
18. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28:1039-1057
19. Friedman S, Khoury-Collado F, Dalloul M, Sherer DM, Abulafia O. Glucose challenge test threshold values in screening for gestational diabetes among black women. Am J Obstet Gynecol 2006; 194: e46-48
20. Chandna A, Zuberi LM, Munim S. Threshold values for the glucose challenge test in pregnancy. Int J Gynaecol Obstet 2006;94: 119-120
21. Poyhonen-Alho MK, Teramo KA, Kaaja RJ, Hiilesmaa VK. 50 gram oral glucose challenge test combined with riskfactor-based screening for gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2005;121:34-37
22. Nahum GG, Huffaker BJ. Racial differences in oral glucose screening test results: establishing race-specific criteria for abnormality in pregnancy. Obstet Gynecol 1993;81:517-522
23. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101: 380-392
24. Dudhbhai M, Lim L, Bombard A, et al. Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: comparison with normal and gestational diabetic patients. Am J Obstet Gynecol 2006,194: e42-e45
25. Montagnana M, Lippi G, Targher G, Fava C, Cesare Guid C. Glucose Challenge Test Does not Predict Gestational Diabetes Mellitus. Inter Med 2008;47:1171-1174

Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi

Yıl 2010, Cilt: 41 Sayı: 3, 123 - 127, 01.04.2010

Gazi Yıldırım Canan Yılmaz Fırat Ersan Rukset Attar Aslı Somunkıran Narter Yeşildağlar Ateş Karateke D. Cem Fıçıcıoğlu

Öz

Amaç: Gestasyonel diabet (GDM) tanısı koymak için 1 saatlik 50 gr glukoz tarama testinde (Glucose Challenge Test-GCT) bir eşik değer belirlemek. Materyal ve Metod: Bu retrospektif çalışmaya glukoz tarama testi pozitif çıkan 95 gebe dahil edildi. Bu gruba 1 hafta sonra 100 gr oral glukoz tolerans testi (OGTT) uygulandı. Test sonucuna gore diabet tanısı alan ve almayan hastaların verileri üzerinde kıyaslama yapıldı. Bulgular: Bu 95 gebenin 58'inde (%61.1) OGTT sonucu da pozitif olarak geldi ve GDM tanısı aldılar. Sonucu pozitif olduğu halde OGTT tahlili normal olanların oranı ise %38.9 (37/95) idi. Normal gebelerin GCT değer ortalaması 155.8±9.3 mg/dl, GDM grubunun ise 165.8±14.7 mg/dl idi (p=0.001). GCT eşik değeri 140 mg/dl alındığında sensitivite %86 iken spesifisite %19 e düşmekte idi. Eşik değer 200 mg/dl olarak kabul edildiğinde ise sensitivite %5, spesifisite ise %100 idi. Sonuç: GDM tanısı sadece GCT deki tek bir eşik değer göre konulamaz. Günümüzde hala GDM tanısının iki basamaklı GCT ve OGTT ile yapılması en uygun program gibi görülmektedir.

Anahtar Kelimeler

Kaynakça

1. Lain KY, Catalano PM. Metabolic changes in pregnancy. Clin Obstet Gynecol 2007;50(4):938-948
2. American Diabetes Assosiation: Gestational diabetes mellitus (Position Statement). Diabetes Care 2004;27 (Suppl. 1):S88-S90
3. Karcaaltincaba D, Kandemir O, Yalvaç S, Guvendag-Guven S, Haber al A. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria. Int J Gynaecol Obstet. 2009; 106:246-249
4. American College of Obstetricians and Gynecologists (ACOG), Committee on Practice Bulletins - Obstetrics. Clinical Management Guidelinesfor Obstetricians- Gynecologists. ACOG Practice Bulletin No. 30. Washington, DC: ACOG, 2001
5. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the US Preventive Services Task Force. Obstet Gynecol 2003,101: 380-92
6. Lanni SM, Barrett DP. The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a highrisk population. The Journal of Maternal-Fetal and Neonatal Medicine 2004;15:375-379
7. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144(7):768-73
8. Moore TR. Diabetes in pregnancy. In Creasy R, ResnickR, eds. Maternal Fetal Medicine, 4th edn. Philadelphia, PA: WB Saunders Company, 1999:964-95
9. Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee, Diabetes Care 1998;21(Suppl. 2):B161-B167
10. American College of Obstetricians and Gynecologists: Diabetes and Pregnancy, Technical Bulletin No. 200, December 1994
11. Hanna FWF, Peters JR. Screening for gestational diabetes; past, present and future. Diabetic Med 2002; 19:351-358
12. Davidson MB. Counterpoint: the oral glucose tolerance test is superfluous. Diabetes Care2002;25:1883-1885
13. Tuomilehto J. Point: a glucose tolerance test is important for clinical practice. Diabetes Care 2002; 25:1880-1882
14. Agarwal MM, Punnose J, Dhatt GS (2004) Gestational diabetes: problems associated with the oral glucose tolerance lest. Diabetes Res Clin Pract63:73-74
15. Miyakoshi K, Tanaka M, Ueno K, Uehara K, Ishimoto H, Yoshimura Y. Cutoff value of 1 h, 50 g glucose challenge testfor screening of gestational diabetes mellitus in a Japanese population. Diabet Research Clin Pract 2003;60:63-67
16. Jang HJ, Cho NH, Jung KB, Oh KS, Dooley SL, Metzger BL. Screening for gestational diabetes mellitus in Korea. Int J Gynaecol Obstet 1995;51:115-122
17. Yalcin HR, Zorlu CG. Threshold value of glucose screening tests in pregnancy: could it be standardizedfor every population? Am J Perinatol 1996,1996:13:317-320
18. National Diabetes Data Group. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979; 28:1039-1057
19. Friedman S, Khoury-Collado F, Dalloul M, Sherer DM, Abulafia O. Glucose challenge test threshold values in screening for gestational diabetes among black women. Am J Obstet Gynecol 2006; 194: e46-48
20. Chandna A, Zuberi LM, Munim S. Threshold values for the glucose challenge test in pregnancy. Int J Gynaecol Obstet 2006;94: 119-120
21. Poyhonen-Alho MK, Teramo KA, Kaaja RJ, Hiilesmaa VK. 50 gram oral glucose challenge test combined with riskfactor-based screening for gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2005;121:34-37
22. Nahum GG, Huffaker BJ. Racial differences in oral glucose screening test results: establishing race-specific criteria for abnormality in pregnancy. Obstet Gynecol 1993;81:517-522
23. Brody SC, Harris R, Lohr K. Screening for gestational diabetes: a summary of the evidence for the U.S. Preventive Services Task Force. Obstet Gynecol 2003; 101: 380-392
24. Dudhbhai M, Lim L, Bombard A, et al. Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: comparison with normal and gestational diabetic patients. Am J Obstet Gynecol 2006,194: e42-e45
25. Montagnana M, Lippi G, Targher G, Fava C, Cesare Guid C. Glucose Challenge Test Does not Predict Gestational Diabetes Mellitus. Inter Med 2008;47:1171-1174

Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil	Türkçe
Bölüm	Makaleler
Yazarlar	Gazi Yıldırım Bu kişi benim Canan Yılmaz Bu kişi benim Fırat Ersan Bu kişi benim Rukset Attar Bu kişi benim Aslı Somunkıran Bu kişi benim Narter Yeşildağlar Bu kişi benim Ateş Karateke Bu kişi benim D. Cem Fıçıcıoğlu Bu kişi benim
Yayımlanma Tarihi	1 Nisan 2010
Yayımlandığı Sayı	Yıl 2010 Cilt: 41 Sayı: 3

Kaynak Göster

APA	Yıldırım, G., Yılmaz, C., Ersan, F., Attar, R., vd. (2010). Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni, 41(3), 123-127. https://doi.org/10.16948/zktb.91307
AMA	Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC. Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni. Nisan 2010;41(3):123-127. doi:10.16948/zktb.91307
Chicago	Yıldırım, Gazi, Canan Yılmaz, Fırat Ersan, Rukset Attar, Aslı Somunkıran, Narter Yeşildağlar, Ateş Karateke, ve D. Cem Fıçıcıoğlu. “Gebelik sırasında 50 Gr Glukoz Tarama Testi Pozitif Olan hastaların 100 Gr Oral Glukoz Tolerans Testi sonuçlarının Retrospektif Olarak değerlendirilmesi”. Zeynep Kamil Tıp Bülteni 41, sy. 3 (Nisan 2010): 123-27. https://doi.org/10.16948/zktb.91307.
EndNote	Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC (01 Nisan 2010) Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni 41 3 123–127.
IEEE	G. Yıldırım, C. Yılmaz, F. Ersan, R. Attar, A. Somunkıran, N. Yeşildağlar, A. Karateke, ve D. C. Fıçıcıoğlu, “Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi”, Zeynep Kamil Tıp Bülteni, c. 41, sy. 3, ss. 123–127, 2010, doi: 10.16948/zktb.91307.
ISNAD	Yıldırım, Gazi vd. “Gebelik sırasında 50 Gr Glukoz Tarama Testi Pozitif Olan hastaların 100 Gr Oral Glukoz Tolerans Testi sonuçlarının Retrospektif Olarak değerlendirilmesi”. Zeynep Kamil Tıp Bülteni 41/3 (Nisan 2010), 123-127. https://doi.org/10.16948/zktb.91307.
JAMA	Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC. Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni. 2010;41:123–127.
MLA	Yıldırım, Gazi vd. “Gebelik sırasında 50 Gr Glukoz Tarama Testi Pozitif Olan hastaların 100 Gr Oral Glukoz Tolerans Testi sonuçlarının Retrospektif Olarak değerlendirilmesi”. Zeynep Kamil Tıp Bülteni, c. 41, sy. 3, 2010, ss. 123-7, doi:10.16948/zktb.91307.
Vancouver	Yıldırım G, Yılmaz C, Ersan F, Attar R, Somunkıran A, Yeşildağlar N, Karateke A, Fıçıcıoğlu DC. Gebelik sırasında 50 gr glukoz tarama testi pozitif olan hastaların 100 gr oral glukoz tolerans testi sonuçlarının retrospektif olarak değerlendirilmesi. Zeynep Kamil Tıp Bülteni. 2010;41(3):123-7.

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