Glycemic status during pregnancy according to fasting and post-load glucose values: The association with adverse pregnancy outcomes. An observational study - 27/09/23
, Sopio Tatulashvili a, b, Eric Vicaut c, Sara Pinto d, Meriem Sal a, Charlotte Nachtergaele c, Narimane Berkane a, Amélie Benbara e, Marion Fermaut e, Jean-Jacques Portal c, Lionel Carbillon e, Hélène Bihan a
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Highlights |
• | Hyperglycemia in pregnancy (HIP) is diagnosed through fasting and/or post-load (after an oral glucose tolerance test) glucose values. |
• | Prognosis of treated HIP may differ according to whether diagnosis is based on high fasting and/or high post-load glucose values. |
• | Compared with no HIP, fasting HIP is independently associated with a higher rate of large-for-gestational-age infant. |
• | Compared with no HIP, post-load HIP is independently associated with higher preterm delivery and neonatal intensive care unit admission rates. |
Abstract |
Aim |
Prognosis of treated hyperglycemia in pregnancy (HIP) may differ according to whether diagnosis following an oral glucose tolerance test (OGTT) is based on high fasting and/or high post-load glucose values.
Methods |
From a multiethnic prospective study, we included 8,339 women screened for HIP after 22 weeks of gestation. We evaluated the risk of large-for-gestational-age (LGA) infant (primary endpoint) and other adverse pregnancy outcomes according to HIP status in four groups defined as follows: no HIP (n = 6,832, reference); isolated fasting HIP (n = 465), isolated post-load HIP (n = 646), and fasting and post-load HIP (n = 396).
Results |
After adjusting for age, body mass index, ethnicity, smoking during pregnancy and parity, compared with no HIP, the adjusted odds ratios [95% confidence interval] for LGA infant were higher in the isolated fasting HIP (1.47 [1.11–1.96]) and fasting and post-load HIP (1.65 [1.23–2.21]) groups, but not in the isolated post-load HIP (1.13 [0.86–1.48]) group. The adjusted odds ratios for preterm delivery and neonatal intensive care unit were higher in the post-load HIP group (1.44 [1.03–2.03] and 1.28 [1.04–1.57], respectively), the fasting and post-load HIP group (1.81 [1.23–2.68] and 1.42 [1.10–1.81], respectively) but not in the isolated fasting HIP group (1.34 [0.90–2.00] and 1.20 [0.94–1.52], respectively).
Conclusion |
Despite glucose-lowering care and adjustment for confounders, compared with no HIP, fasting HIP was associated with a higher rate of LGA infant, whereas post-load HIP was associated with higher preterm delivery and neonatal intensive care unit admission rates.
Le texte complet de cet article est disponible en PDF.Keywords : Diabetes in pregnancy, Gestational diabetes mellitus, Hyperglycemia in pregnancy, Oral glucose tolerance test, Large-for-gestational-age infant, Pregnancy outcomes
Abbreviations : 1h-PG, 2h-PG, BMI, DIP, FPG, GDM, HIP, HOMA-B, HOMA-IR, IADPSG, LGA, NICU, OGTT, SGA, WG, WHO
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Vol 49 - N° 5
Article 101469- septembre 2023 Retour au numéro
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