ABSTRACT
_ Objective_ To analyze the relationship between the fasting plasma glucose ( FPG ) of pre-pregnancy women and occurrence of gestational diabetes mellitus( GDM) , and to explore the value of risk evaluation of GDM by lowerling cut-point for impaired fasting glucose ( IFG ) . Methods The general clinic check information before pregnancy, the plasma glucose levels during 24-28 weeks of pregnancy and pregnancy outcomes were collected prospectively in Weifang and Zhucheng Maternal and Child Health Hospital between February 2014 and November 2014. The FPG levels of the recruited women were lower than 6. 1 mmol/L. According to the criteria for GDM of Ministry of Health (MOH)of China in 2011, and based on the results of 75 g oral glucose tolerance test, pregnant women who underwent screening for GDM were recruited and separated into normal group and GDM group. Based on the FPG levels before pregnancy and according to the recommendation as American Diabetes Association ( ADA ) suggested in 2003, recruited women with normal FPG level according to World Health Organization ( WHO) criteria (1999)were divided into 5. 6-6. 1 mmol/L and<5. 6 mmol/L groups. Results Among the child-bearing age women with FPG<6. 1 mmol/L, the incidences of GDM and macrosomia were 19. 2% and 8. 2% respectively. In the group with FPG between 5. 6 and 6. 1 mmol/L, incidences of GDM and macrosomia were 34. 2% and 4. 7%respectively. While in the group with FPG<5. 6 mmol/L, incidences of GDM and macrosomia were 13. 2% and 15. 3% respectively. The risks of GDM and macrosomia were increased by 2. 6 times and 3. 3 times respectively in group with FPG between 5. 6 and 6. 1 mmol/L (34. 5%), compared with that in group with FPG<5. 6 mmol/L(P<0. 01). Age, FPG, and body mass index before pregnancy in GDM group were significantly higher than those in normal group. The receiver operating characteristic curves in predicting GDM showed that the optimum cut-points for age, FPG, and body mass index were 30 years old, 5. 55 mmol/L, and 23. 7 kg/m2 respectively. Conclusions The risk of GDM in childbearing aged women with FPG from 5. 55 to 6. 10 mmol/L was markedly increased. The optimum cut-point for FPG (5. 55 mmol/L) in predicting GDM was close to the low limit for IFG (5. 6 mmol/L) suggested by ADA in 2003. Decreasing the lower limit of IFG to 5. 6 mmol/L among women who checked before pregnancy and paying attention to those women with FPG from 5. 6 to 6. 1 mmol/L would have advantage to the evaluation and prevention of GDM.
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Objective To analyze the relationship of the serum concentration of TSH in pregestational women with pregnancy and pregnant outcome,and to investigate the high risk value of TSH in eugenic and healthy examination before pregnancy.Methods The distribution of TSH in fertile woman and the relationship of serum TSH level with sex hormone levels,rate of pregnancy,and adverse pregnant outcomes (no healthy infants were born,abortion,premature delivery,and malformation) were investigated in national-free pregestational eugenic and healthy examination during 2013.The high risk level of TSH in pregestational women was determined.Results The average level of TSH in 5 798 prepregnant women was 2.36 mIU/L with the median of 2.01 mIU/L,and the serum level of TSH showed abnormal distribution with long tail.The pregnant rate of fertile women within one year was 76.1％.The beneficial range of TSH levels for pregnancy was 0.35-3.5 mIU/L,while the pregnant rate in other ranges of TSH level was decreased with statistically significant difference (P＜0.01).When the concentration of TSH was below 0.35 mIU/L or above 5.5 mIU/L,abnormal pregnant outcomes were significantly increased (P＜0.01).Logistic regression analysis indicated that the relative risks of infertility and abnormal pregnant outcomes were significantly increased.Compared with TSH 0.35-2.5 mIU/L group,there were significantly differences in FSH,LH,and estradiol (E2) in TSH＞4.5 mIU/L or＜0.35 mIU/L group (P＜0.01).TSH was related with LH,E2,progesterone,and prolactin (r=0.29,-0.28,-0.37,0.36).Conclusion The high risk value of serum TSH in prepregnant women should be below 0.35 mIU/L or above 5.5 mIU/L.
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Objective To improve the quality of the clinical hematologic examination laboratories in national free preconception health examination project by using randomized blind sample test in the external quality assessment (EQA ) schemes .Methods Blind samples for clinical hematologic examination were prepared as higher ,middle ,lower three levels .Samples were dispensed in u‐nified way which included 4 times conventional EQA and in random way which included 1 time blind sample test .Samples will be tested by Clinical hematologic examination laboratories in national free preconception health examination project .The feedback re‐sults were summarized and analyzed by EQA organizer .Results In 4 times of conventional EQA ,the rates of accepted score of 134 laboratories were 72 .4% ,97 .8% ,97 .0% and 98 .5% respectively .The rates of accepted score in last three times were statistically significant higher than that in the first time(P<0 .05) .However ,the rates of accepted score (84 .3% ) in randomized blind sample test were significant lower than that(97 .0% ) in conventional EQA which was conducted at the same time(P<0 .05) .Conclusion The use of randomized blind sample test may help the EQA organizer to find the problems in laboratories participated EQA and find effective way to improve the quality of the laboratories .