Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes

Celeste P. Durnwald, Lisa Mele, Catherine Y. Spong, Susan M. Ramin, Michael W. Varner, Dwight J. Rouse, Anthony Sciscione, Patrick Catalano, George Saade, Yoram Sorokin, Jorge E. Tolosa, Brian Casey, Garland D. Anderson

Research output: Contribution to journalArticle

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Abstract

Objective: To estimate the association between fasting and 2-hour postprandial blood glucose levels and neonatal outcomes in women treated for mild gestational diabetes. Methods: In this secondary analysis of a multicenter randomized treatment trial of mild gestational diabetes, the median fasting and 2-hour postprandial glucose levels were analyzed in 2-week intervals and change over time (slope) was calculated for women with gestational diabetes (abnormal oral glucose tolerance test) and a fasting glucose less than 95 mg/dL who received nutritional management with self blood glucose monitoring and insulin as needed. Regression analyses were performed to estimate the relationship between median fasting and postprandial glucose and neonatal fat mass, cord blood C-peptide, birth weight, large-for-gestational-age neonates, macrosomia (greater than 4,000 g), and neonatal hypoglycemia. Results: Among 460 women with gestational diabetes, median fasting (P<.001), postprandial breakfast (P<.001), and postprandial lunch (P<.001) glucose values declined over the treatment period, whereas postprandial dinner values remained stable (P=.83). Higher median fasting glucose during the first 2 weeks of treatment was significantly associated with increased odds ratios for neonatal fat mass (1.35; 95% CI 1.09-1.66; P=.006) and elevated C-peptide (1.29; CI 1.09-1.52; P=.003). Higher median fasting glucose during the last 2 weeks before delivery was associated with higher rates of large-for-gestational-age neonates (1.27; CI 1.05-1.53; P=.01), macrosomia (1.32; CI 1.04-1.65; P = .02), and elevated C-peptide (1.19; CI 1.03-1.38; P=.02). Conclusion: In women treated for mild gestational diabetes, higher fasting glucose during initiation of diet therapy was associated with increased neonatal fat mass and elevated C-peptide and during the last 2 weeks before delivery with macrosomia, large-for-gestational age, and elevated C-peptide.

Original languageEnglish (US)
Pages (from-to)819-827
Number of pages9
JournalObstetrics and Gynecology
Volume117
Issue number4
DOIs
StatePublished - Apr 2011

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Gestational Diabetes
Fasting
C-Peptide
Glucose
Gestational Age
Fats
Postprandial Period
Newborn Infant
Blood Glucose Self-Monitoring
Diet Therapy
Lunch
Breakfast
Glucose Tolerance Test
Fetal Blood
Hypoglycemia
Birth Weight
Meals
Blood Glucose
Therapeutics
Odds Ratio

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Durnwald, C. P., Mele, L., Spong, C. Y., Ramin, S. M., Varner, M. W., Rouse, D. J., ... Anderson, G. D. (2011). Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. Obstetrics and Gynecology, 117(4), 819-827. https://doi.org/10.1097/AOG.0b013e31820fc6cf

Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. / Durnwald, Celeste P.; Mele, Lisa; Spong, Catherine Y.; Ramin, Susan M.; Varner, Michael W.; Rouse, Dwight J.; Sciscione, Anthony; Catalano, Patrick; Saade, George; Sorokin, Yoram; Tolosa, Jorge E.; Casey, Brian; Anderson, Garland D.

In: Obstetrics and Gynecology, Vol. 117, No. 4, 04.2011, p. 819-827.

Research output: Contribution to journalArticle

Durnwald, CP, Mele, L, Spong, CY, Ramin, SM, Varner, MW, Rouse, DJ, Sciscione, A, Catalano, P, Saade, G, Sorokin, Y, Tolosa, JE, Casey, B & Anderson, GD 2011, 'Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes', Obstetrics and Gynecology, vol. 117, no. 4, pp. 819-827. https://doi.org/10.1097/AOG.0b013e31820fc6cf
Durnwald, Celeste P. ; Mele, Lisa ; Spong, Catherine Y. ; Ramin, Susan M. ; Varner, Michael W. ; Rouse, Dwight J. ; Sciscione, Anthony ; Catalano, Patrick ; Saade, George ; Sorokin, Yoram ; Tolosa, Jorge E. ; Casey, Brian ; Anderson, Garland D. / Glycemic characteristics and neonatal outcomes of women treated for mild gestational diabetes. In: Obstetrics and Gynecology. 2011 ; Vol. 117, No. 4. pp. 819-827.
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abstract = "Objective: To estimate the association between fasting and 2-hour postprandial blood glucose levels and neonatal outcomes in women treated for mild gestational diabetes. Methods: In this secondary analysis of a multicenter randomized treatment trial of mild gestational diabetes, the median fasting and 2-hour postprandial glucose levels were analyzed in 2-week intervals and change over time (slope) was calculated for women with gestational diabetes (abnormal oral glucose tolerance test) and a fasting glucose less than 95 mg/dL who received nutritional management with self blood glucose monitoring and insulin as needed. Regression analyses were performed to estimate the relationship between median fasting and postprandial glucose and neonatal fat mass, cord blood C-peptide, birth weight, large-for-gestational-age neonates, macrosomia (greater than 4,000 g), and neonatal hypoglycemia. Results: Among 460 women with gestational diabetes, median fasting (P<.001), postprandial breakfast (P<.001), and postprandial lunch (P<.001) glucose values declined over the treatment period, whereas postprandial dinner values remained stable (P=.83). Higher median fasting glucose during the first 2 weeks of treatment was significantly associated with increased odds ratios for neonatal fat mass (1.35; 95{\%} CI 1.09-1.66; P=.006) and elevated C-peptide (1.29; CI 1.09-1.52; P=.003). Higher median fasting glucose during the last 2 weeks before delivery was associated with higher rates of large-for-gestational-age neonates (1.27; CI 1.05-1.53; P=.01), macrosomia (1.32; CI 1.04-1.65; P = .02), and elevated C-peptide (1.19; CI 1.03-1.38; P=.02). Conclusion: In women treated for mild gestational diabetes, higher fasting glucose during initiation of diet therapy was associated with increased neonatal fat mass and elevated C-peptide and during the last 2 weeks before delivery with macrosomia, large-for-gestational age, and elevated C-peptide.",
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AU - Mele, Lisa

AU - Spong, Catherine Y.

AU - Ramin, Susan M.

AU - Varner, Michael W.

AU - Rouse, Dwight J.

AU - Sciscione, Anthony

AU - Catalano, Patrick

AU - Saade, George

AU - Sorokin, Yoram

AU - Tolosa, Jorge E.

AU - Casey, Brian

AU - Anderson, Garland D.

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N2 - Objective: To estimate the association between fasting and 2-hour postprandial blood glucose levels and neonatal outcomes in women treated for mild gestational diabetes. Methods: In this secondary analysis of a multicenter randomized treatment trial of mild gestational diabetes, the median fasting and 2-hour postprandial glucose levels were analyzed in 2-week intervals and change over time (slope) was calculated for women with gestational diabetes (abnormal oral glucose tolerance test) and a fasting glucose less than 95 mg/dL who received nutritional management with self blood glucose monitoring and insulin as needed. Regression analyses were performed to estimate the relationship between median fasting and postprandial glucose and neonatal fat mass, cord blood C-peptide, birth weight, large-for-gestational-age neonates, macrosomia (greater than 4,000 g), and neonatal hypoglycemia. Results: Among 460 women with gestational diabetes, median fasting (P<.001), postprandial breakfast (P<.001), and postprandial lunch (P<.001) glucose values declined over the treatment period, whereas postprandial dinner values remained stable (P=.83). Higher median fasting glucose during the first 2 weeks of treatment was significantly associated with increased odds ratios for neonatal fat mass (1.35; 95% CI 1.09-1.66; P=.006) and elevated C-peptide (1.29; CI 1.09-1.52; P=.003). Higher median fasting glucose during the last 2 weeks before delivery was associated with higher rates of large-for-gestational-age neonates (1.27; CI 1.05-1.53; P=.01), macrosomia (1.32; CI 1.04-1.65; P = .02), and elevated C-peptide (1.19; CI 1.03-1.38; P=.02). Conclusion: In women treated for mild gestational diabetes, higher fasting glucose during initiation of diet therapy was associated with increased neonatal fat mass and elevated C-peptide and during the last 2 weeks before delivery with macrosomia, large-for-gestational age, and elevated C-peptide.

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