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

Alison M. Stuebe; Mark B. Landon; Yinglei Lai; Mark Klebanoff; Susan M. Ramin; Ronald J. Wapner; Michael W. Varner; Dwight J. Rouse; Anthony Sciscione; Patrick Catalano; George Saade; Yoram Sorokin; Alan M. Peaceman; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD

doi:10.1055/s-0034-1543949

American Journal of Perinatology, Inhaltsverzeichnis

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

¹Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Mark B. Landon

²Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

,

Yinglei Lai

³George Washington University Biostatistics Center, Washington, District of Columbia

,

Mark Klebanoff

⁴Nationwide Children's Hospital, Columbus, Ohio

,

Susan M. Ramin

⁵The University of Texas Health Science Center at Houston, Houston, Texas

,

Ronald J. Wapner

⁶Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Michael W. Varner

⁷Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah

,

Dwight J. Rouse

⁸University of Alabama at Birmingham, Birmingham, Alabama

,

Anthony Sciscione

⁹Drexel University, Philadelphia, Pennsylvania

,

Patrick Catalano

¹⁰Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio

,

George Saade

¹¹Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Yoram Sorokin

¹²Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan

,

Alan M. Peaceman

¹³Department 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

› Institutsangaben

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

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Referenzen

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