The relationship between maternal glycemia and perinatal outcome.

Abstract

OBJECTIVE:

To examine the relationship between varying degrees of maternal hyperglycemia and pregnancy outcomes.

METHODS:

This was a secondary analysis of a treatment trial for mild gestational diabetes including four cohorts: 1) 473 women with untreated mild gestational diabetes; 2) 256 women with a positive 50-g screen and one abnormal oral glucose tolerance test (OGTT) value; 3) 675 women with a positive screen and no abnormal OGTT values; and 4) 437 women with a normal 50-g screen. Groups were compared by test of trend for a composite perinatal outcome (neonatal hypoglycemia, hyperbilirubinemia, elevated cord C-peptide level, and perinatal trauma or death), frequency of large for gestational age neonates, shoulder dystocia, and pregnancy-related hypertension. Three-hour OGTT levels (fasting, 1-, 2-, and 3-hour) levels were divided into categories and analyzed for their relationship to perinatal and maternal outcomes.

RESULTS:

There were significant trends by glycemic status among the four cohorts for the composite and all other outcomes (P<.001). Analysis for trend according to OGTT categories showed an increasing relationship between fasting and all postload levels and the various outcomes (P<.05). Fasting glucose 90 mg/dL or greater and 1 hour 165 mg/dL or greater were associated with an increased risk for the composite outcome (odds ratios and 95% confidence intervals of 2.0 [1.03–4.15] and 1.46 [1.02–2.11] to 1.52 [1.08–2.15] for the fasting and 1 hour, respectively). A 1 hour glucose 150 mg/dL or greater was associated with an increased risk for large for gestational age (odds ratios, 1.8 [1.02–3.18] to 2.35 [1.35–4.14]); however, 2- and 3-hour glucose levels did not increase the risk for the composite or large for gestational age until well beyond current gestational diabetes diagnostic thresholds.

CONCLUSION:

A monotonic relationship exists between increasing maternal glycemia and perinatal morbidity. Current OGTT criteria require reevaluation in determining thresholds for the diagnosis and treatment of gestational diabetes.

LEVEL OF EVIDENCE:

II

• Authors: Mark B Landon, Lisa Mele, Catherine Y Spong, Marshall W Carpenter, Susan M Ramin, Brian Casey, Ronald J Wapner, Michael W Varner, Dwight J Rouse, John M Thorp Jr, Anthony Sciscione, Patrick Catalano, Margaret Harper, George Saade, Steve N Caritis, Yoram Sorokin, Alan M Peaceman, Jorge E Tolosa, Garland D Anderson, Eunice Kennedy Shriver National Institute of Child Health, and Human Development (NICHD) Maternal–Fetal Medicine Units (MFMU) Network
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 117 Issue 2 Pt 1 Pg. 218-224 (Feb 2011) ISSN: 1873-233X [Electronic] United States
• PMID: 21309194 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Blood Glucose

Topics

• Adult
• Blood Glucose
• Diabetes, Gestational (epidemiology)
• Female
• Glucose Tolerance Test
• Humans
• Infant, Newborn
• Logistic Models
• Pregnancy
• Pregnancy Outcome (epidemiology)
• Randomized Controlled Trials as Topic
• United States (epidemiology)
• Young Adult