Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated

• Published in: Diabetes care Vol. 26; no. 7; pp. 2107 - 2111
• Main Authors: Ostlund, Ingrid, Hanson, Ulf, Bjorklund, Anders, Hjertberg, Ragnhild
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2003
• Subjects: Adult; Biological and medical sciences; Birth Weight; Body Weight; Cesarean Section - statistics & numerical data; Diabetes; Diabetes, Gestational - complications; Diabetes. Impaired glucose tolerance; Diseases of mother, fetus and pregnancy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glucose; Glucose Intolerance - diagnosis; Gynecology. Andrology. Obstetrics; Humans; Hypertension - epidemiology; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal - statistics & numerical data; Medical sciences; Medicin; Medicine; Morbidity; Odds Ratio; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Reference Values; Sweden; Sweden; Endocrinopathy; Pregnancy; Human; Prognosis; Treatment; Mother; Fetus; Impaired glucose tolerance; Premature; Intensive Care Units; Newborn; Infant; Diabetes; Gestational/complications; Neonatal/statistics & numerical data
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/diacare.26.7.2107

Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated Ingrid Östlund , MD, PHD 1 2 , Ulf Hanson , MD, PHD 1 , Anders Björklund , MD, PHD 3 , Ragnhild Hjertberg , MD, PHD 4 , Nord Eva , MD 5 , Elisabeth Nordlander , MD, PHD 5 , Swahn Marja-Liisa , MD, PHD 6 and Jan Wager , MD, PHD 6 1 Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden 2 Department of Obstetrics & Gynecology, Örebro University Hospital, Örebro, Sweden 3 Danderyd’s Hospital, Stockholm, Sweden 4 Stockholm South Hospital and Octavia Clinic, Stockholm, Sweden 5 Karolinska Hospital, Stockholm, Sweden 6 Huddinge University Hospital, Stockholm, Sweden Address correspondence and reprint requests to Ingrid Östlund, MD, Department of Obstetrics & Gynecology, Örebro University Hospital, SE-701 85 ÖREBRO, Sweden. E-mail: ingrid.ostlund{at}orebroll.se . Abstract OBJECTIVE —To evaluate whether there is increased maternal or neonatal morbidity in connection with impaired glucose tolerance (IGT) during pregnancy when the condition is not treated. RESEARCH DESIGN AND METHODS —During the study period of 1997–2001, in a defined geographical area in Sweden, the diagnostic criteria for gestational diabetes mellitus (GDM) were limited to the criteria for diabetes. Prospectively, 213 women who were identified with IGT during pregnancy were undiagnosed and untreated. Data on maternal and fetal outcome was collected from records. For each case subject, four control subjects were taken from the same delivery department. RESULTS —The proportion of women who underwent cesarean section was significantly higher in the case subjects than in the control subjects and was independently associated with IGT. The adjusted odds ratio (OR) was 1.9 (95% CI 1.2–2.9). The proportion of infants who were large for gestational age (LGA), defined as birth weight >2 SDs greater than the mean for gestation and sex, was independently significantly associated with untreated IGT during pregnancy (OR 7.3, 95% CI 4.1–12.7). Admission to a neonatal intensive care unit (NICU) for 2 days or longer was more common (adjusted OR 2.0, 95% CI 1.1–3.8). However, 71.3% of the children in the IGT group and 87.3% of the control subjects had no neonatal complications. CONCLUSIONS —There is increased independent association between cesarean section rate, prematurity, LGA, and macrosomic infants born to mothers with untreated IGT. Most of the children were healthy, but there is still increased morbidity. Therefore, to evaluate the effects of treatment, there is a need for a randomized study. GDM, gestational diabetes mellitus IGT, impaired glucose tolerance LGA, large for gestational age NICU, neonatal intensive care unit OGTT, oral glucose tolerance test PIH, pregnancy-induced hypertension Footnotes A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Accepted March 23, 2003. Received November 11, 2002. DIABETES CARE