Download PDF
Am J Perinatol 2015; 32(09): 833-838
DOI: 10.1055/s-0034-1543949
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is There a Threshold Oral Glucose Tolerance Test Value for Predicting Adverse Pregnancy Outcome?

Alison M. Stuebe
1   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Mark B. Landon
2   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Yinglei Lai
3   George Washington University Biostatistics Center, Washington, District of Columbia
,
Mark Klebanoff
4   Nationwide Children's Hospital, Columbus, Ohio
,
Susan M. Ramin
5   The University of Texas Health Science Center at Houston, Houston, Texas
,
Ronald J. Wapner
6   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Michael W. Varner
7   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Dwight J. Rouse
8   University of Alabama at Birmingham, Birmingham, Alabama
,
Anthony Sciscione
9   Drexel University, Philadelphia, Pennsylvania
,
Patrick Catalano
10   Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
,
George Saade
11   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
12   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
Alan M. Peaceman
13   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD › Author Affiliations
Further Information

Publication History

12 June 2014

14 November 2014

Publication Date:
16 January 2015 (online)

    Permissions and Reprints

Abstract

Objective This study aims to determine whether there is a threshold 3-hour oral glucose tolerance test (OGTT) value associated with accelerated risk of adverse pregnancy outcomes.

Study Design In a secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, we used generalized additive models with smoothing splines to explore nonlinear associations between each of the 3-hour OGTT values (fasting, 1-hour, 2-hour, and 3-hour) and adverse pregnancy outcomes, including the study's composite outcome (perinatal mortality, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/or birth trauma), large for gestational age birth weight, small for gestational age birth weight, shoulder dystocia, neonatal hypoglycemia, gestational hypertension (gHTN), and preeclampsia.

Results Among the 1,360 eligible women, each timed OGTT value was linearly associated with increased odds of composite adverse outcome. We found evidence of a departure from linearity only for the association between fasting glucose and gHTN/preeclampsia, with a stronger association for values of 85 to 94 mg/dL (p = 0.03). We found no evidence of departure from linearity for any other OGTT values and measured outcomes (all chi-square test p-values ≥ 0.05).

Conclusion In a population of untreated women with mild gestational glucose intolerance and fasting OGTT < 95 mg/dL, we found an increasing risk of gHTN with a fasting glucose between 85 and 94 mg/dL.

Keywords

gestational diabetes - glucose - preeclampsia - macrosomia

Note

The preliminary results were presented as a poster: Is there a threshold OGTT value for predicting adverse neonatal outcome? Poster presented at: 31st Annual Meeting of the Society for Maternal-Fetal Medicine; February 11, 2011; San Francisco, CA. Poster 538.


* The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network are mentioned below.


 

  • References

  • 1 O'Sullivan JB. Gestational diabetes. Unsuspected, asymptomatic diabetes in pregnancy. N Engl J Med 1961; 264: 1082-1085
    CrossrefPubMedGoogle Scholar
  • 2 Metzger BE, Lowe LP, Dyer AR , et al; HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358 (19) 1991-2002
    CrossrefPubMedGoogle Scholar
  • 3 Metzger BE, Buchanan TA, Coustan DR , et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30 (2) (Suppl. 02) S251-S260
    CrossrefPubMedGoogle Scholar
  • 4 Landon MB, Spong CY, Thom E , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009; 361 (14) 1339-1348
    CrossrefPubMedGoogle Scholar
  • 5 Alexander GR, Kogan MD, Himes JH. 1994-1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender. Matern Child Health J 1999; 3 (4) 225-231
    CrossrefPubMedGoogle Scholar
  • 6 Hastie T, Tibshirani R. Generalized Additive Models. London: Chapman and Hall; 1990
    Google Scholar
  • 7 Sermer M, Naylor CD, Gare DJ , et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol 1995; 173 (1) 146-156
    CrossrefPubMedGoogle Scholar
  • 8 Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention. Diabet Med 2002; 19 (9) 708-723
    CrossrefPubMedGoogle Scholar
  • 9 Catalano PM, Huston L, Amini SB, Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes mellitus. Am J Obstet Gynecol 1999; 180 (4) 903-916
    CrossrefPubMedGoogle Scholar
  • 10 Stuebe AM, Landon MB, Lai Y , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD. Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol 2012; 207 (1) 62.e1-62.e7
    CrossrefPubMedGoogle Scholar