Elevated Glucose Challenge Test in a Nondiabetic Index Pregnancy and Gestational Diabetes in a Subsequent Pregnancy

Abstract

Objective The aim of this study was to evaluate whether a 1-hour glucose challenge test (GCT) ≥140 mg/dL in a nondiabetic index pregnancy is associated with the development of gestational diabetes mellitus (GDM) in a subsequent pregnancy.

Study Design We performed a retrospective cohort study from a single institution from June 2009 to December 2018. Women with a nondiabetic index singleton gestation who underwent a 1-hour GCT at 24 to 28 weeks and had a successive singleton delivery were included. GDM was defined by a 1-hour GCT of ≥ 200 mg/dL, ≥2 of 4 elevated values on a 3-hour GCT, or a diagnosis of GDM defined by International Classification of Disease codes in the electronic medical record. Univariable analyses were performed to evaluate the associations between an elevated 1-hour GCT result in the index pregnancy, maternal characteristics, and the development of GDM in the subsequent pregnancy. Variables found to be significant (p < 0.05) were included in multivariable analysis.

Results A total of 2,423 women were included. Of these, 340 (14.0%) had an elevated 1-hour GCT in the index pregnancy. Women with an elevated 1-hour GCT in the index pregnancy compared with those without were significantly more likely to be older, married, privately insured, of Hispanic ethnicity or Asian race, chronically hypertensive, have a higher body mass index (BMI), have a shorter inter-pregnancy interval, and to develop GDM in the subsequent pregnancy (14.4 vs. 3.3%, p < 0.001). In multivariable analysis, an elevated 1-hour GCT (adjusted odds ratio [aOR]: 4.54, 95% confidence interval [CI]: 3.02–6.81), first-trimester BMI ≥30 kg/m² in the index pregnancy (aOR: 3.10, 95% CI: 2.03–4.71), Asian race (aOR: 2.96, 95% CI: 1.70–5.12), Hispanic ethnicity (aOR: 2.11, 95% CI: 1.12–4.00), and increasing age (aOR: 1.07, 95% CI: 1.02–1.12) were significantly associated with an increased risk of GDM in the subsequent pregnancy.

Conclusion An elevated 1-hour GCT in a nondiabetic index pregnancy is associated with a fourfold increased risk of GDM in a subsequent pregnancy.

Key Points

• An abnormal 1 hour GCT in an index pregnancy is associated with GDM in a subsequent pregnancy.

• An abnormal 1 hour GCT may be an independent risk factor for GDM in a subsequent pregnancy.

• An abnormal 1 hour GCT is associated with a 4 fold increased risk of GDM in a subsequent pregnancy.

Keywords

elevated glucose tolerance - screening tests - gestational diabetes - pregnancy outcomes - risk factors for gestational diabetes

Publikationsverlauf

Eingereicht: 13. Juli 2020

Angenommen: 05. März 2021

Artikel online veröffentlicht:
27. Mai 2021

• References

• 1 Correa A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J 2015; 19 (03) 635-642
• 2 Stamilio DM, Olsen T, Ratcliffe S, Sehdev HM, Macones GA. False-positive 1-hour glucose challenge test and adverse perinatal outcomes. Obstet Gynecol 2004; 103 (01) 148-156
• 3 Khan KS, Hashmi FA, Rizvi JH. Are non-diabetic women with abnormal glucose screening test at increased risk of pre-eclampsia, macrosomia and caesarian birth?. J Pak Med Assoc 1995; 45 (07) 176-179
• 4 Cheng YW, Block-Kurbisch I, Caughey AB. Carpenter-Coustan criteria compared with the national diabetes data group thresholds for gestational diabetes mellitus. Obstet Gynecol 2009; 114 (2 Pt 1): 326-332
• 5 Ferrara A, Hedderson MM, Quesenberry CP, Selby JV. Prevalence of gestational diabetes mellitus detected by the national diabetes data group or the Carpenter and Coustan plasma glucose thresholds. Diabetes Care 2002; 25 (09) 1625-1630
• 6 Hedderson MM, Gunderson EP, Ferrara A. Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol 2010; 115 (03) 597-604
• 7 Hanley GE, Hutcheon JA, Kinniburgh BA, Lee L. Interpregnancy interval and adverse pregnancy outcomes an analysis of successive pregnancies. Obstet Gynecol 2017; 129 (03) 408-415
• 8 Institute of Medicine and National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Re-examining IOM Pregnancy Weight Guidelines. In: Weight Gain During Pregnancy: Reexamining the Guidelines 2009; 78 (01) 69-77
• 9 Lowe LP, Metzger BE, Dyer AR. et al. Hyperglycemia and adverse pregnancy outcome (HAPO) study: an overview. In: Gestational Diabetes During and After Pregnancy. 2010
• 10 Corrado F, D'Anna R, Cannata ML. et al. Positive association between a single abnormal glucose tolerance test value in pregnancy and subsequent abnormal glucose tolerance. Am J Obstet Gynecol 2007; 196 (04) 339.e1-339.e5
• 11 Farrar D, Duley L, Dowswell T, Lawlor DA. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev 2017; 8: CD007122
• 12 Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D. Diagnosis of gestational diabetes mellitus: falling through the net. Diabetologia 2015; 58 (09) 2003-2012
• 13 Prutsky GJ, Domecq JP, Sundaresh V. et al. Screening for gestational diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98 (11) 4311-4318
• 14 Harper LM, Jauk V, Longo S, Biggio JR, Szychowski JM, Tita AT. Early gestational diabetes screening in obese women: a randomized controlled trial. Am J Obstet Gynecol 2020; 222 (05) 495.e1-495.e8
• 15 Committee on Practice Bulletins–Obstetrics. ACOG Practice Bulletin No. 190. Obstet Gynecol 2018; 131 (02) e49-e64
• 16 Lu GC, Luchesse A, Chapman V, Cliver S, Rouse DJ. Screening for gestational diabetes mellitus in the subsequent pregnancy: is it worthwhile?. Am J Obstet Gynecol 2002; 187 (04) 918-921