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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 李建南(Chien-Nan Lee) | |
dc.contributor.author | Yi-Yun Tai | en |
dc.contributor.author | 戴怡芸 | zh_TW |
dc.date.accessioned | 2021-06-17T08:10:14Z | - |
dc.date.available | 2019-08-27 | |
dc.date.copyright | 2019-08-27 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-08-16 | |
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Mean Age of Mothers is on the Rise: United States, 2000-2014. NCHS Data Brief: 1-8. 30. MCGROGAN A, SNOWBALL J AND DE VRIES CS. 2014. Pregnancy losses in women with Type 1 or Type 2 diabetes in the UK: an investigation using primary care records. Diabet Med 31: 357-365. 31. MCINTYRE HD, COLAGIURI S, ROGLIC G AND HOD M. 2015. Diagnosis of GDM: a suggested consensus. Best Pract Res Clin Obstet Gynaecol 29: 194-205. 32. POOMALAR GK AND RANGASWAMY V. 2013. A comparison of fasting plasma glucose and glucose challenge test for screening of gestational diabetes mellitus. J Obstet Gynaecol 33: 447-450. 33. QIAO Q, NAKAGAMI T, TUOMILEHTO J, BORCH-JOHNSEN K, BALKAU B, IWAMOTO Y, TAJIMA N, INTERNATIONAL DIABETES EPIDEMIOLOGY G AND GROUP DS. 2000. Comparison of the fasting and the 2-h glucose criteria for diabetes in different Asian cohorts. Diabetologia 43: 1470-1475. 34. RESNICK HE, HARRIS MI, BROCK DB AND HARRIS TB. 2000. American Diabetes Association diabetes diagnostic criteria, advancing age, and cardiovascular disease risk profiles: results from the Third National Health and Nutrition Examination Survey. Diabetes Care 23: 176-180. 35. RISKIN-MASHIAH S, YOUNES G, DAMTI A AND AUSLENDER R. 2009. First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care 32: 1639-1643. 36. SAVVIDOU M, NELSON SM, MAKGOBA M, MESSOW CM, SATTAR N AND NICOLAIDES K. 2010. First-trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures. Diabetes 59: 3017-3022. 37. SESHIAH V, BALAJI V, BALAJI MS, PANEERSELVAM A, ARTHI T, THAMIZHARASI M AND DATTA M. 2008. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu)--a community based study. J Assoc Physicians India 56: 329-333. 38. STUMVOLL M, GOLDSTEIN BJ AND VAN HAEFTEN TW. 2005. Type 2 diabetes: principles of pathogenesis and therapy. Lancet 365: 1333-1346. 39. TEEDE HJ, HARRISON CL, TEH WT, PAUL E AND ALLAN CA. 2011. Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention. Aust N Z J Obstet Gynaecol 51: 499-504. 40. VAN LEEUWEN M, OPMEER BC, ZWEERS EJ, VAN BALLEGOOIE E, TER BRUGGE HG, DE VALK HW, VISSER GH AND MOL BW. 2010. Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history. BJOG 117: 69-75. 41. WAHABI HA, ESMAEIL SA, FAYED A, AL-SHAIKH G AND ALZEIDAN RA. 2012. Pre-existing diabetes mellitus and adverse pregnancy outcomes. BMC Res Notes 5: 496. 42. WEI JN, LI HY, SUNG FC, LIN CC, CHIANG CC, LI CY AND CHUANG LM. 2007. Birth weight correlates differently with cardiovascular risk factors in youth. Obesity (Silver Spring) 15: 1609-1616. 43. WU ET, NIEN FJ, KUO CH, CHEN SC, CHEN KY, CHUANG LM, LI HY AND LEE CN. 2016. Diagnosis of more gestational diabetes lead to better pregnancy outcomes: Comparing the International Association of the Diabetes and Pregnancy Study Group criteria, and the Carpenter and Coustan criteria. J Diabetes Investig 7: 121-126. 44. XU L, JIANG CQ, LAM TH, CHENG KK, YUE XJ, LIN JM, ZHANG WS AND THOMAS GN. 2010. Impact of impaired fasting glucose and impaired glucose tolerance on arterial stiffness in an older Chinese population: the Guangzhou Biobank Cohort Study-CVD. Metabolism 59: 367-372. 45. ZHU WW ET AL. 2013. Fasting plasma glucose at 24-28 weeks to screen for gestational diabetes mellitus: new evidence from China. Diabetes Care 36: 2038-2040. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/73787 | - |
dc.description.abstract | 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。 | zh_TW |
dc.description.abstract | 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. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T08:10:14Z (GMT). No. of bitstreams: 1 ntu-108-P06421022-1.pdf: 676607 bytes, checksum: cf5f9e536d357918b52d9e55c2582080 (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 口試委員會審定書 i
中文摘要 ii 英文摘要 iv 誌謝 v 目錄 vi Chapter 1、Introduction 1 1.1 Gestational diabetes 1 1.2 Screening for gestational diabetes 2 1.3 The role of fasting plasma glucose at the first prenatal visit 5 1.4 Pathophysiology of GDM and aging 8 1.5 Aim of the study 10 Chapter 2、Material and methods 11 2.1 Study design 11 2.2 Model design 12 2.3 Statistical analysis 13 2.4 Ethics Approval 14 Chapter 3、Results 15 3.1 Clinical characteristics of study subjects 15 3.2 Fasting plasma glucose and age at first prenatal visit 16 3.3 Screen algorithms of GDM 16 3.4 Evaluation of screen algorithms 17 Chapter 4、Discussion 18 4.1 Main findings of this cohort 18 4.2 Comparison to literature 19 4.3 Health implications and clinical relevance 21 4.4 The percentage of the false negative 22 4.5 Strengths and limitations 23 4.6 Conclusions 24 References 25 Table Legends 31 Figure Legends 35 | |
dc.language.iso | zh-TW | |
dc.title | 早期妊娠糖尿病之篩檢:年紀與空腹血糖的角色 | zh_TW |
dc.title | Simplifying the gestational diabetes screening by maternal age plus fasting plasma glucose at first prenatal visit: a prospective cohort study | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 林芯?(Shin-Yu Lin) | |
dc.contributor.oralexamcommittee | 李弘元(Hung-Yuan Li),周祖述(Tzuu-Shuh Jou) | |
dc.subject.keyword | 妊娠期糖尿病,第一孕期篩檢,空腹血糖,年紀,糖水檢測, | zh_TW |
dc.subject.keyword | early screen,gestational diabetes,age,OGTT, | en |
dc.relation.page | 41 | |
dc.identifier.doi | 10.6342/NTU201903701 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-08-16 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
顯示於系所單位: | 臨床醫學研究所 |
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