Pregnancy Outcomes in Women with 1-Hour Glucose Challenge Test ≥ 200 mg/dL

Abstract

Objective Many protocols diagnose gestational diabetes mellitus (GDM) solely on a 1-hour glucose challenge test (GCT) ≥ 200 mg/dL. However, pregnancy outcomes in these women compared with women diagnosed with a 3-hour glucose tolerance test (GTT) has not been adequately evaluated. We hypothesize that a 1-hour GCT ≥ 200 mg/dL is associated with worse pregnancy outcomes as compared with a GCT 135 to 199 mg/dL with positive GTT.

Study Design A retrospective cohort of singleton pregnancies complicated by GDM. Maternal outcomes included A2DM, preeclampsia, primary cesarean, and failed trial of labor after cesarean. Perinatal outcomes were large/small for gestational age, shoulder dystocia, and birth injury. Groups were compared with t-test and chi-square test, and logistic regression to adjust for confounders.

Results A total of 602 women diagnosed with GDM by 1-hour GCT 135 to 199 mg/dL and confirmatory 3-hour GTT (< 200 group) and 225 women diagnosed with 1-hour GCT ≥ 200 alone (≥ 200) were included. The ≥ 200 group had a higher incidence of preeclampsia (16.4 vs. 10.6%) and shoulder dystocia (3.1 vs. 1.0%). Adjusted odds ratio and 95% confidence interval were 1.80 (1.10–2.94) and 5.10 (1.25–20.76), respectively.

Conclusion Preeclampsia and shoulder dystocia are more frequent in women with GCT ≥ 200 mg/dL than those with a positive GTT following a GCT of 135 to 199 mg/dL.

Keywords

gestational diabetes - shoulder dystocia - preeclampsia - birth injury

Note

Dr. Harper is supported by K12HD001258–13, PI WW Andrews, which partially supported this study.

This article was presented as a poster at the 34th Annual Meeting of the Society of Maternal-Fetal Medicine; February 3–8, 2014; New Orleans, LA.

• References

• 1 American Diabetes Association. Clinical practice recommendations 2001: gestational diabetes mellitus. Diabetes Care 2001; 24 (Suppl. 01) S77-S79
• 2 Committee on Practice Bulletins–Obstetrics. Practice bulletin no. 137: Gestational diabetes mellitus. Obstet Gynecol 2013; 122 (2 Pt 1): 406-416
• 3 Vandorsten JP, Dodson WC, Espeland MA , et al; National Institutes of Health Consensus Development Conference Statement. NIH consensus development conference: diagnosing gestational diabetes mellitus. NIH Consens State Sci Statements 2013; 29 (1) 1-31
• 4 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
• 5 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS ; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352 (24) 2477-2486
• 6 American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes Care 2012; 35 (Suppl. 01) S11-S63
• 7 Shivvers SA, Lucas MJ. Gestational diabetes. Is a 50-g screening result > or = 200 mg/dL diagnostic?. J Reprod Med 1999; 44 (8) 685-688
• 8 Lanni S, Barrett D. The predictive value of the 1-h 50-g glucose screen for diagnosing gestational diabetes mellitus in a high-risk population. J Matern Fetal Neonatal Med 2004; 15 (6) 375-379
• 9 Atia HC, Koren Y, Weintraub AY, Novack L, Sheiner E. Is a value of over 200 mg/dL in the oral glucose tolerance test, a marker of severity in patients with gestational diabetes mellitus?. J Matern Fetal Neonatal Med 2013; 26 (13) 1259-1262
• 10 Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982; 144 (7) 768-773
• 11 Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol 1996; 87 (2) 163-168
• 12 Friedman S, Khoury-Collado F, Dalloul M, Sherer DM, Abulafia O. Glucose challenge test threshold values in screening for gestational diabetes among black women. Am J Obstet Gynecol 2006; 194 (5) e46-e48
• 13 Korucuoglu U, Biri A, Turkyilmaz E , et al. Glycemic levels with glucose loading test during pregnancy and its association with maternal and perinatal outcomes. Diabetes Res Clin Pract 2008; 80 (1) 69-74
• 14 Figueroa D, Landon MB, Mele L , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Relationship between 1-hour glucose challenge test results and perinatal outcomes. Obstet Gynecol 2013; 121 (6) 1241-1247