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, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD, J Thorp, K Dorman, S Brody, S Timlin, J Bernhardt, B Casey, K Leveno, L Moseley, J Gold, D Bradford, L Fay, M Garcia, F Capellan, M Miodovnik, F Malone, S Bousleiman, H Husami, V Carmona, N Fredericks, E Gantioqui, B Greenspan, M Williams, K Anderson, P Ashby, S McAllister, S Quinn, A Guzman, F Castinella, J Steiner, J Parker, J Sheppard, J Tisdale, A Northen, W Andrews, M Carpenter, D Catlow, D Allard, M Seebeck, J Tillinghast, J Iams, F Johnson, C Latimer, E Weinandy, B Maselli, M Hoffman, E Guzman, M Talucci, T Grossman, C Perez, L Zeghibe, P Tabangin, B Mercer, B Stetzer, C Milluzzi, W Dalton, S Pichette, M Harper, M Swain, P Meis, J White, L Gilstrap, K Cannon, J Martinez, D Dusek, J Moss, J Brandon, A Jackson, G Hankins, D Sharp, S Caritis, M Bickus, H Birkland, M Cotroneo, N Cuddy, G Norman, P Lockhart, S Blackwell, L Quast, P Simon, G Mallett, J Tolosa, L Davis, E Lairson, C Cromett, C Naze, M Blaser, E Thom, L Mele, J Zachary, B Getachew, C Cobb, L Leuchtenburg, S Gilbert, C Spong, S Tolivaisa, K Howell, G D Anderson, 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, Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network, Bethesda, MD, J Thorp, K Dorman, S Brody, S Timlin, J Bernhardt, B Casey, K Leveno, L Moseley, J Gold, D Bradford, L Fay, M Garcia, F Capellan, M Miodovnik, F Malone, S Bousleiman, H Husami, V Carmona, N Fredericks, E Gantioqui, B Greenspan, M Williams, K Anderson, P Ashby, S McAllister, S Quinn, A Guzman, F Castinella, J Steiner, J Parker, J Sheppard, J Tisdale, A Northen, W Andrews, M Carpenter, D Catlow, D Allard, M Seebeck, J Tillinghast, J Iams, F Johnson, C Latimer, E Weinandy, B Maselli, M Hoffman, E Guzman, M Talucci, T Grossman, C Perez, L Zeghibe, P Tabangin, B Mercer, B Stetzer, C Milluzzi, W Dalton, S Pichette, M Harper, M Swain, P Meis, J White, L Gilstrap, K Cannon, J Martinez, D Dusek, J Moss, J Brandon, A Jackson, G Hankins, D Sharp, S Caritis, M Bickus, H Birkland, M Cotroneo, N Cuddy, G Norman, P Lockhart, S Blackwell, L Quast, P Simon, G Mallett, J Tolosa, L Davis, E Lairson, C Cromett, C Naze, M Blaser, E Thom, L Mele, J Zachary, B Getachew, C Cobb, L Leuchtenburg, S Gilbert, C Spong, S Tolivaisa, K Howell, G D Anderson
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.
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Source: PubMed