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Relationship between 1-Hour Glucose Challenge Test Results and Perinatal Outcomes

Citation

Figueroa, Dana; Landon, Mark B.; Mele, Lisa; Spong, Catherine Y.; Ramin, Susan M.; Casey, Brian M.; Wapner, Ronald J.; Varner, Michael W.; Thorp, John M., Jr.; & Sciscione, Anthony C., et al. (2013). Relationship between 1-Hour Glucose Challenge Test Results and Perinatal Outcomes. Obstetrics & Gynecology, 121(6), 1241-1247. PMCID: PMC4029107

Abstract

OBJECTIVE: To estimate the relationship between 1-hour 50 g glucose challenge test values and perinatal outcomes.
METHODS: This was a secondary analysis of data from a multicenter treatment trial of mild gestational diabetes mellitus. Women with glucose challenge test values of 135-199 mg/dL completed a 3-hour oral glucose tolerance test. Mild gestational diabetes mellitus was defined as fasting glucose less than 95 mg/dL and two or more abnormal oral glucose tolerance test values: 1-hour 180 mg/dL or more; 2-hour 155 mg/dL or more; and 3-hour 140 mg/dL or more. Our study included untreated women with glucose challenge test values of 135-139 mg/dL and 140-199 mg/dL and a comparison group with values less than 120 mg/dL. Primary outcomes included a perinatal composite (stillbirth, neonatal death, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and birth trauma), large for gestational age (LGA, birth weight above the 90 percentile based on sex-specific and race-specific norms), and macrosomia (greater than 4,000 g).
RESULTS: There were 436 women with glucose challenge test values less than 120 mg/dL and 1,403 with values of 135 mg/dL or more (135-139, n=135; 140-199, n=1,268). The composite perinatal outcome occurred in 25.6% of those with glucose challenge test values less than 120 mg/dL compared with 21.1% for values of 135-139 mg/dL and 35.3% for values of 140-199 mg/dL. Rates of LGA by group were 6.6%, 6.8%, and 12.4%, respectively. Rates of macrosomia by group were 7.8%, 6.1%, and 12.1%, respectively. Compared with glucose challenge test values less than 120 mg/dL, the adjusted odds ratios (ORs) (95% confidence intervals [CIs]) for values of 140-199 mg/dL were 1.48 (1.14-1.93) for the composite outcome, 1.97 (1.29-3.11) for LGA, and 1.61 (1.07-2.49) for macrosomia. For glucose challenge test values of 135-139 mg/dL, adjusted ORs and 95% CIs were 0.75 (0.45-1.21), 1.04 (0.44-2.24), and 0.75 (0.30-1.66), respectively. The subcategories with glucose challenge test values of 140-144 mg/dL and 145-149 mg/dL also were associated with an increase in selected outcomes when compared with those with values less than 120 mg/dL.
CONCLUSIONS: Glucose challenge test values of 135-139 mg/dL were not associated with adverse outcomes compared with values less than 120 mg/dL; however, glucose challenge test values of 140 mg/dL or more were associated with an increase in odds of the composite perinatal outcome, LGA, and macrosomia.

URL

http://dx.doi.org/10.1097/AOG.0b013e31829277f5

Reference Type

Journal Article

Year Published

2013

Journal Title

Obstetrics & Gynecology

Author(s)

Figueroa, Dana
Landon, Mark B.
Mele, Lisa
Spong, Catherine Y.
Ramin, Susan M.
Casey, Brian M.
Wapner, Ronald J.
Varner, Michael W.
Thorp, John M., Jr.
Sciscione, Anthony C.
Catalano, Patrick M.
Harper, Margaret A.
Saade, George R.
Caritis, Steve N.
Sorokin, Yoram
Peaceman, Alan M.
Tolosa, Jorge E., for the
Eunice Kennedy Shriver
National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network

PMCID

PMC4029107