Anna P. Kenyon, MBChB, MD; Andrew H. Shennan, MBBS, MD
Is nondiabetic maternal hyperglycemia diabetes associated with adverse pregnancy outcomes?
Cohort study (Hyperglycemia and Adverse Pregnancy Outcome [HAPO] study) with follow-up to delivery.
15 centers in the US, Canada, Barbados, UK, the Netherlands, Israel, Thailand, Hong Kong, Singapore, and Australia.
25 505 women ≥ 18 years of age (mean age 29 y) who were pregnant with a singleton fetus of known gestational age and had an oral glucose tolerance test at 24 to 32 weeks of gestation. Exclusion criteria included previous glucose testing in the current pregnancy, diagnosis of diabetes before or during the current pregnancy, conception by fertility treatment, and infection with HIV or hepatitis B or C virus. Women were excluded after enrollment if they had a 2-hour plasma glucose level diagnostic of diabetes (> 11.1 mmol/L [200 mg/dL]), fasting plasma glucose level > 5.8 mmol/L (105 mg/dL), or other glucose results in an unsafe range (in which case, caregivers were provided with the results) (2.9% of women); had glucose testing or delivery outside the study (5.5%); or were missing key outcome data (0.1%). 23 316 women were included in the analysis.
Fasting, 1-hour, and 2-hour plasma glucose levels (blinded).
Birthweight > 90th percentile for gestational age, cord-blood serum C-peptide level > 90th percentile, primary cesarean section, and clinical neonatal hypoglycemia.
Risk for each adverse outcome increased with increasing maternal glucose levels (Table). Frequencies in the lowest and highest categories, respectively, of fasting blood glucose were 5.3% and 26% for birthweight > 90th percentile, 3.7% and 32% for cord-blood serum C-peptide level > 90th percentile, 13% and 28% for primary cesarean section, and 2.1% and 4.6% for clinical neonatal hypoglycemia.
Maternal hyperglycemia that is less severe than that which is diagnostic of diabetes was associated with adverse pregnancy outcomes in a continuous manner with no obvious thresholds.
Association between maternal glucose levels at mean 28 weeks of gestation and adverse pregnancy outcomes*
*SD = standard deviation. Odds ratios adjusted for multiple other risk factors. 1 SD for fasting plasma glucose = 0.4 mmol/L (6.9 mg/dL); 1 SD for 1-h plasma glucose = 1.7 mmol/L (31 mg/dL); 1 SD for 2-h plasma glucose = 1.3 mmol/L (24 mg/dL).
Anna P. Kenyon, Andrew H. Shennan. Nondiabetic maternal hyperglycemia was associated with adverse pregnancy outcomes. Ann Intern Med. 2008;149:JC2–6. doi: 10.7326/0003-4819-149-4-200808190-02006
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Published: Ann Intern Med. 2008;149(4):JC2-6.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Infectious Disease.
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