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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
1   Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Mark B. Landon
2   Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
,
Yinglei Lai
3   George Washington University Biostatistics Center, Washington, District of Columbia
,
Mark Klebanoff
4   Nationwide Children's Hospital, Columbus, Ohio
,
Susan M. Ramin
5   The University of Texas Health Science Center at Houston, Houston, Texas
,
Ronald J. Wapner
6   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Michael W. Varner
7   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Dwight J. Rouse
8   University of Alabama at Birmingham, Birmingham, Alabama
,
Anthony Sciscione
9   Drexel University, Philadelphia, Pennsylvania
,
Patrick Catalano
10   Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio
,
George Saade
11   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
12   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
Alan M. Peaceman
13   Department 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 › Author Affiliations
Further Information

Publication History

12 June 2014

14 November 2014

Publication Date:
16 January 2015 (online)

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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

Note

The preliminary results were presented as a poster: Is there a threshold OGTT value for predicting adverse neonatal outcome? Poster presented at: 31st Annual Meeting of the Society for Maternal-Fetal Medicine; February 11, 2011; San Francisco, CA. Poster 538.


* The other members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units Network are mentioned below.


 

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