The relationship between maternal glycemia and perinatal outcome

Mark B. Landon, Lisa Mele, Catherine Y. Spong, Marshall W. Carpenter, Susan M. Ramin, Brian Casey, Ronald J. Wapner, Michael W. Varner, Dwight J. Rouse, John M. Thorp, Anthony Sciscione, Patrick Catalano, Margaret Harper, George Saade, Steve N. Caritis, Yoram Sorokin, Alan M. Peaceman, Jorge E. Tolosa, Garland D. Anderson

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Objective: To examine the relationship between varying degrees of maternal hyperglycemia and pregnancy outcomes. Methods: This was a secondary analysis of a treatment trial for mild gestational diabetes including four cohorts: 1) 473 women with untreated mild gestational diabetes; 2) 256 women with a positive 50-g screen and one abnormal oral glucose tolerance test (OGTT) value; 3) 675 women with a positive screen and no abnormal OGTT values; and 4) 437 women with a normal 50-g screen. Groups were compared by test of trend for a composite perinatal outcome (neonatal hypoglycemia, hyperbilirubinemia, elevated cord C-peptide level, and perinatal trauma or death), frequency of large for gestational age neonates, shoulder dystocia, and pregnancy-related hypertension. Three-hour OGTT levels (fasting, 1-, 2-, and 3-hour) levels were divided into categories and analyzed for their relationship to perinatal and maternal outcomes. Results: There were significant trends by glycemic status among the four cohorts for the composite and all other outcomes (P<.001). Analysis for trend according to OGTT categories showed an increasing relationship between fasting and all postload levels and the various outcomes (P<.05). Fasting glucose 90 mg/dL or greater and 1 hour 165 mg/dL or greater were associated with an increased risk for the composite outcome (odds ratios and 95% confidence intervals of 2.0 [1.03-4.15] and 1.46 [1.02-2.11] to 1.52 [1.08-2.15] for the fasting and 1 hour, respectively). A 1 hour glucose 150 mg/dL or greater was associated with an increased risk for large for gestational age (odds ratios, 1.8 [1.02-3.18] to 2.35 [1.35-4.14]); however, 2- and 3-hour glucose levels did not increase the risk for the composite or large for gestational age until well beyond current gestational diabetes diagnostic thresholds. Conclusion: A monotonic relationship exists between increasing maternal glycemia and perinatal morbidity. Current OGTT criteria require reevaluation in determining thresholds for the diagnosis and treatment of gestational diabetes.

Original languageEnglish (US)
Pages (from-to)218-224
Number of pages7
JournalObstetrics and Gynecology
Volume117
Issue number2 PART 1
DOIs
StatePublished - Feb 2011
Externally publishedYes

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Glucose Tolerance Test
Gestational Diabetes
Mothers
Fasting
Gestational Age
Glucose
Odds Ratio
Neonatal Hyperbilirubinemia
Dystocia
C-Peptide
Pregnancy Outcome
Hypoglycemia
Hyperglycemia
Newborn Infant
Confidence Intervals
Hypertension
Morbidity
Pregnancy
Wounds and Injuries
Therapeutics

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Landon, M. B., Mele, L., Spong, C. Y., Carpenter, M. W., Ramin, S. M., Casey, B., ... Anderson, G. D. (2011). The relationship between maternal glycemia and perinatal outcome. Obstetrics and Gynecology, 117(2 PART 1), 218-224. https://doi.org/10.1097/AOG.0b013e318203ebe0

The relationship between maternal glycemia and perinatal outcome. / Landon, Mark B.; Mele, Lisa; Spong, Catherine Y.; Carpenter, Marshall W.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.; Anderson, Garland D.

In: Obstetrics and Gynecology, Vol. 117, No. 2 PART 1, 02.2011, p. 218-224.

Research output: Contribution to journalArticle

Landon, MB, Mele, L, Spong, CY, Carpenter, MW, Ramin, SM, Casey, B, Wapner, RJ, Varner, MW, Rouse, DJ, Thorp, JM, Sciscione, A, Catalano, P, Harper, M, Saade, G, Caritis, SN, Sorokin, Y, Peaceman, AM, Tolosa, JE & Anderson, GD 2011, 'The relationship between maternal glycemia and perinatal outcome', Obstetrics and Gynecology, vol. 117, no. 2 PART 1, pp. 218-224. https://doi.org/10.1097/AOG.0b013e318203ebe0
Landon MB, Mele L, Spong CY, Carpenter MW, Ramin SM, Casey B et al. The relationship between maternal glycemia and perinatal outcome. Obstetrics and Gynecology. 2011 Feb;117(2 PART 1):218-224. https://doi.org/10.1097/AOG.0b013e318203ebe0
Landon, Mark B. ; Mele, Lisa ; Spong, Catherine Y. ; Carpenter, Marshall W. ; Ramin, Susan M. ; Casey, Brian ; Wapner, Ronald J. ; Varner, Michael W. ; Rouse, Dwight J. ; Thorp, John M. ; Sciscione, Anthony ; Catalano, Patrick ; Harper, Margaret ; Saade, George ; Caritis, Steve N. ; Sorokin, Yoram ; Peaceman, Alan M. ; Tolosa, Jorge E. ; Anderson, Garland D. / The relationship between maternal glycemia and perinatal outcome. In: Obstetrics and Gynecology. 2011 ; Vol. 117, No. 2 PART 1. pp. 218-224.
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AU - Casey, Brian

AU - Wapner, Ronald J.

AU - Varner, Michael W.

AU - Rouse, Dwight J.

AU - Thorp, John M.

AU - Sciscione, Anthony

AU - Catalano, Patrick

AU - Harper, Margaret

AU - Saade, George

AU - Caritis, Steve N.

AU - Sorokin, Yoram

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N2 - Objective: To examine the relationship between varying degrees of maternal hyperglycemia and pregnancy outcomes. Methods: This was a secondary analysis of a treatment trial for mild gestational diabetes including four cohorts: 1) 473 women with untreated mild gestational diabetes; 2) 256 women with a positive 50-g screen and one abnormal oral glucose tolerance test (OGTT) value; 3) 675 women with a positive screen and no abnormal OGTT values; and 4) 437 women with a normal 50-g screen. Groups were compared by test of trend for a composite perinatal outcome (neonatal hypoglycemia, hyperbilirubinemia, elevated cord C-peptide level, and perinatal trauma or death), frequency of large for gestational age neonates, shoulder dystocia, and pregnancy-related hypertension. Three-hour OGTT levels (fasting, 1-, 2-, and 3-hour) levels were divided into categories and analyzed for their relationship to perinatal and maternal outcomes. Results: There were significant trends by glycemic status among the four cohorts for the composite and all other outcomes (P<.001). Analysis for trend according to OGTT categories showed an increasing relationship between fasting and all postload levels and the various outcomes (P<.05). Fasting glucose 90 mg/dL or greater and 1 hour 165 mg/dL or greater were associated with an increased risk for the composite outcome (odds ratios and 95% confidence intervals of 2.0 [1.03-4.15] and 1.46 [1.02-2.11] to 1.52 [1.08-2.15] for the fasting and 1 hour, respectively). A 1 hour glucose 150 mg/dL or greater was associated with an increased risk for large for gestational age (odds ratios, 1.8 [1.02-3.18] to 2.35 [1.35-4.14]); however, 2- and 3-hour glucose levels did not increase the risk for the composite or large for gestational age until well beyond current gestational diabetes diagnostic thresholds. Conclusion: A monotonic relationship exists between increasing maternal glycemia and perinatal morbidity. Current OGTT criteria require reevaluation in determining thresholds for the diagnosis and treatment of gestational diabetes.

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