Using 1990-1995 data, the authors examined the influence of post-challenge maternal
glucose concentration on pregnancy outcome in 1,157 nondiabetic US gravidas. After control for potential confounding variables and comparing gravidas with lower
glucose concentrations (<99 mg/dl) with the others, they found that mean
birth weight increased by 50 g and 200 g with
glucose concentrations of 99-130 mg/dl and >130 mg/dl, respectively. Increased maternal
glucose concentration also was associated with an increased risk of large-for-gestation fetuses (p for trend < 0.001) and a decreased risk of
fetal growth restriction (p for trend < 0.05). The association between
glucose and gestation was inverse and significantly shortened when
glucose concentrations were higher. Maternal complications increased twofold or more with high
glucose concentrations and included
cesarean section and clinical
chorioamnionitis.
Chorioamnionitis in combination with high maternal
glucose concentration increased the risk of very preterm delivery almost 12-fold. These observations extend Pedersen's hypothesis-that high concentrations of maternal
glucose give rise to increased nutrient transfer to the fetus and increase fetal growth, beyond the model of maternal diabetes (Acta Endocrinol 1954;16:330-42). They raise the question of whether higher, but seemingly normal maternal
glucose concentration predisposes to or is a marker for placental
inflammation and
infection.