شيوع اختلالات آزمايش چالش گلوكز (GCT) در خانم هاي باردار مراجعه كننده به آزمايشگاه خاتم الانبيا شهرستان اراك

Disorders of glucose challenge test (GCT) in pregnant women referred to Khatam-o-allanbia laboratory of Arak city, Iran

ديــابت حامــلگي، شايع ترين اختلال مــتابوليك در طي حاملـگي بوده كه در صورت عدم تشخيص، موجب افزايش ريسك 3 تا 4 برابري بــرخي اخــتلالات در مادر و جنين مي شود (1). وقوع ديابت حاملگي از 1% تا 14% گزارش شده و 90% حاملگي هاي مرتبط با ديابت را ناشي از ديابت حاملگي دانسته اند (2). انجمن ديــابت آمــريكا (ADA)، بـه منظور غربالگري و تشخيص ديابت بارداري، آزمايش هاي GCT (آزمـايش چالش گلوكز) و GTT (آزمايش تـــحمل گلوكز) را توصيه مــي نمايد (3). در اين مطالعه مقطعي- تحليلي، از خانم هاي باردار مراجعه كننده در طي هفته هاي 28-24 بارداري به آزمايشگاه خاتم الانبيا شهرستان اراك در سال 1388 پس از شرح و هدف از انجام اين طرح و كسب رضايت نامه كتبي، كه حداقل به ميزان 12-8 ساعت ناشتا بودند، 5 ميلي ليتر خون وريدي تهيه شد. سپس از اين افراد، 1 ساعت پس از مصرف 50 گرم پودر گلوكز، مجددا به منظور انجام آزمايش GCT، نمونه گيري شد. افرادي كه داراي GCT مساوي و يا بالاتر از 130 ميلي گرم در دسي ليتر بودند، جهت انجام آزمايش GTT در طي روزهاي آتي معرفي شدند. براي انجام آزمايش GTT، از افراد پس از 12-8 ساعت، ناشتا بودن، براي انجام آزمايش FPG (گلوكز پلاسماي ناشتا) نمونه گيري شد ، سپس 100 گرم پودر گلوكز به بيمار داده شد. در طي ساعت هاي 1، 2 و 3 پس از مصرف گلوكز نيز از اين افراد خون وريدي تهيه شد كه آزمايش قند با استفاده از كيت اندازه گيري گلوكز شركت پارس آزمون و با استفاده از اتوآنالايزر مدل BS-300 كمپاني Mindry اندازه گيري شد.

Gestational diabetes mellitus (GDM) is the most common metabolic disorder during pregnancy which is associated with 3 to 4 folds of increase in the risk of maternal and fetal morbidity, if it is not diagnosed early (1). Gestational diabetes occurs from 1% to 14%, and 90% of pregnancy-related diabetes has been related to gestational diabetes (2). Glucose challenge test (GCT) and glucose tolerance test (GTT) are recommended by American Diabetes Association (ADA) for screening and diagnosing of gestational diabetes (3). In this cross-sectional study, the subjects were the pregnant women during 24-28 weeks of gestation referred to Khatam-o-allanbia laboratory of Arak city in 2009. First, we explained the aim of the project and then obtained the written consent. After being fast for at least 8-12 hours, five ml of their venous blood was drown. For GCT, the blood samples were obtained one hour after consumption of 50g of glucose powder. The Individuals whose GCT was equal or higher than 130 mg/dl were introduced for GTT in the future days. After 8-12 hours of being fast, blood samples were taken to perform GTT. Then after eating 100 grams of glucose powder, their 1, 2 and 3 hour -venous blood samples were drown to perform glucose test, using glucose testing kit of Pars Azmun Company and Mindary BS-300 autoanalyser. The average age of referred pregnant women is 27.37±10.24 year. Of 417, 403 (96.64%) have normal fasting plasma glucose (? 99 mg/dl) and 14 (3.36%) have abnormal fasting plasma glucose (? 100 mg/dl). When normal GCT is considered ?140 mg/dl and ?130 mg/dl, 357 (85.61%) and 308 (73.56%) have normal GCT and 60 (14.39%) and 109 (26.14%) have abnormal GCT, respectively. The Average of fasting plasma glucose (FPG) and GCT are 83.86 (73-243) and 118.32 (140-351) mg/dl, respectively. In 9 (64.29%) of women with abnormal FPG, the GCT test is also abnormal. By performing GTT for the women whose GCT was equal or higher than 130 mg/dl, 24 (5.76%) were identified with gestational diabetes and introduced for treatment. If 140 mg/dl was considered as a cutoff point of GCT, four women (0.94%) would falsely be non-diabetic. Based on this study, the prevalence of GDM is 5.74% that is not so high, compared to the range of 4.8 to 7.4% of the country (4). A study conducted by Soheilykhah et al. on 1071 pregnant women with GCT of ? 130 mg /dl, 31.9% of the women had abnormal GCT. After doing GTT, 110 patients (10.2%) have been diagnosed with gestational diabetes (2) that is higher than the prevalence of other studies in Iran. Due to results of this study and other studies, it seems that the GCT is not a reliable test for screening gestational diabetes. On the other hand, if GCT is going to be used, further studies are required to review the current Cutoff point of this test. Key words: Glucose challenge test (GCT), Fasting plasma glucose (FPG), Gestational diabetes.