Clinical Outcomes of Pregnancies Complicated by Mild Gestational Diabetes Mellitus Differ by Combinations of Abnormal Oral Glucose Tolerance Test Values
Open Access
- 15 September 2010
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 33 (12), 2524-2530
- https://doi.org/10.2337/dc10-1445
Abstract
OBJECTIVE: To examine the association between levels of hyperglycemia, determined by each prenatal oral glucose tolerance test (OGTT) value (fasting, 1 and 2 h), and maternal and perinatal outcomes and to determine whether the risk for these outcomes differs for women whose value(s) equaled or exceeded the thresholds for gestational diabetes mellitus (GDM) established by the International Association of Diabetes in Pregnancy Study Groups (IADPSG). RESEARCH DESIGN AND METHODS: This article discusses a retrospective study of 8,711 women, delivering at ≥20 weeks' gestation, who had a prenatal 2-h 75-g OGTT without a prior 50-g challenge and were not treated with insulin, glyburide, diet, and/or exercise during pregnancy. Associations between adverse outcomes and elevated OGTT values are reported. RESULTS: After excluding treated women, 19.4% of the remaining women had IADPSG-defined GDM. Continuous fasting, 1- and 2-h OGTT measures, and GDM (yes/no) were significantly associated with most adverse outcomes. However, the magnitude and significance of risk for these outcomes differed by various combinations of abnormal glucose values. Women with normal fasting and elevated postload values were at higher risk for preterm delivery, gestational hypertension, and having an infant with hyperbilirubinema, whereas women with elevated fasting and normal postload values were at higher risk of having a large-for-gestational-age infant, compared with women without GDM. CONCLUSIONS: Risks for different adverse outcomes vary depending on which single or combined IADPSG-defined OGTT thresholds are equaled or exceeded. Prospective studies are needed to determine whether changing pre- and postprandial glucose targets during pregnancy will more uniformly reduce adverse outcomes.Keywords
This publication has 20 references indexed in Scilit:
- Severe obesity, gestational weight gain, and adverse birth outcomesThe American Journal of Clinical Nutrition, 2010
- Maternal Obesity and Risk of Gestational Diabetes MellitusDiabetes Care, 2007
- Summary and Recommendations of the Fifth International Workshop-Conference on Gestational Diabetes MellitusDiabetes Care, 2007
- Comparison of the criteria for gestational diabetes mellitus by NDDG and Carpenter and Coustan, and the outcomes of pregnancyJournal of Endocrinological Investigation, 2002
- Pregnancy Outcomes in Women With Gestational Diabetes Compared With the General Obstetric PopulationObstetrics & Gynecology, 1997
- Toward universal criteria for gestational diabetes: The 75-gram glucose tolerance test in pregnancyAmerican Journal of Obstetrics and Gynecology, 1995
- Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee.1995
- Tight glucose control results in normal perinatal outcome in 150 patients with gestational diabetes.1994
- Size at birth and growth in the first year of life of babies who are overweight and underweight at birthProceedings of the Nutrition Society, 1980
- Screening criteria for high-risk gestational diabetic patientsAmerican Journal of Obstetrics and Gynecology, 1973