GDM and Elevated Fasting vs Post-Load Glucose OGTT Levels: Which is a Better Predictor of Adverse Pregnancy Outcomes?
BACKGROUND AND PURPOSE:
Ryan et al. (Diabetic Medicine 2019) sought to determine the association between gestational diabetes (GDM) OGTT fasting plasma vs post-load glucose levels during pregnancy and LGA and hypertensive outcomes
Retrospective cohort study (2008-2014)
Live singleton births
Study design and data analysis
GDM based upon Diabetes Canada criteria (2 step approach where 2nd step consists of the 75g 2 hour OGTT and a single value meets criteria)
Logistic regression models to determine associations
Adjusted for maternal characteristics and medications
Hypertensive disorders of pregnancy
257,547 pregnancies included | GDM: 5.0%
Elevated fasting plasma glucose: 1.6%
Elevated 1-h and/or 2-h OGTT values: 3.4%
Negative GCT pregnancies: 8.1%
Negative OGTT pregnancies:11.0%
GDM with elevated fasting glucose levels: 22.4%
GDM with elevated post-load levels: 9.1%
Hypertensive disorders of pregnancy rates
Negative GCT pregnancies: 5.1%
Negative OGTT pregnancies: 7.0%
GDM with elevated fasting glucose levels: 11.9%
GDM with elevated post-load levels: 8%
Among GDM pregnancies: Compared to pregnancies with post-load glucose elevations only, those with elevated fasting levels were at higher risk for
LGA: Adjusted odds ratio (OR) 2.66 (95%, CI 2.39 to 2.96)
Hypertensive disorders of pregnancy: Adjusted OR 1.51 (95% CI, 1.33 to 1.72)
Fasting plasma glucose remained significantly associated with adverse outcomes in GDM pregnancies regardless of pharmacological intervention
Elevated fasting plasma glucose is more strongly correlated with LGA and hypertensive disorders of pregnancy vs post-load levels
Authors suggest that
…persistence of adverse outcomes despite treatment suggests that fasting hyperglycaemia may be a marker of some other processes that result in LGA and HDP, and requires further study
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