Department of Obstetrics, Gynecology, and Reproductive Science, Yale University, New Haven, Connecticut.
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Am J Perinatol. 2022 Apr;39(5):464-472. doi: 10.1055/s-0041-1740005. Epub 2021 Dec 31.
This study aimed to determine if one abnormal value of four on the diagnostic 3-hour oral glucose tolerance test (OGTT) is associated with adverse perinatal outcomes in obese women.
This is a secondary analysis of a prospective study of nulliparous women in eight geographic regions. Women with body mass index <30 kg/m and pregestational diabetes mellitus (GDM) were excluded. Four groups were compared: (1) normal 50-g 1-hour glucose screen, (2) elevated 1-hour glucose screen with normal 100-g 3-hour diagnostic OGTT, (3) elevated 1-hour glucose screen and one of four abnormal values on 3-hour OGTT, and (4) GDM. Using multivariable logistic regression adjusting for covariates, the women in the groups with dysglycemia were compared with those in the normal screen group for maternal and neonatal outcomes.
Among 1,713 obese women, 1,418 (82.8%) had a normal 1-hour glucose screen, 125 (7.3%) had a normal 3-hour diagnostic OGTT, 72 (4.2%) had one abnormal value on their diagnostic OGTT, and 98 (5.7%) were diagnosed with GDM. The one abnormal value group had increased risk of large for gestational age (LGA) neonates (adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.31-3.82), cesarean delivery (aOR = 2.19, 95% CI: 1.34-3.58), and hypertensive disorders of pregnancy (aOR = 2.19, 95% CI: 1.32-3.63) compared with normal screens. The one abnormal value group also had an increased risk of preterm birth <37 weeks (aOR = 2.63, 95% CI: 1.43-4.84), neonatal respiratory support (aOR = 2.38, 95% CI: 1.23-4.60), and neonatal hyperbilirubinemia (aOR = 2.00, 95% CI: 1.08-3.71). There was no association between one abnormal value with shoulder dystocia and neonatal hypoglycemia.
For obese women, one abnormal value on the 3-hour OGTT confers increased perinatal adverse outcomes. These women should be studied further to determine if nutrition counseling and closer fetal monitoring improve outcomes even in the absence of a diagnosis of GDM.
· Study of obese women with one abnormal value on OGTT.. · Adverse maternal and neonatal outcomes were found, including more LGA neonates.. · Neonates were not at increased risk of hypoglycemia..
本研究旨在确定肥胖女性在诊断性 3 小时口服葡萄糖耐量试验（OGTT）中出现 4 个异常值之一是否与不良围产期结局相关。
这是对 8 个地理区域的初产妇进行的前瞻性研究的二次分析。排除了 BMI<30kg/m2 和孕前糖尿病（GDM）的女性。比较了以下 4 组：（1）50g 1 小时葡萄糖筛查正常，（2）1 小时葡萄糖筛查升高但 100g 3 小时诊断性 OGTT 正常，（3）1 小时葡萄糖筛查升高且 OGTT 出现 4 个异常值中的 1 个，以及（4）GDM。使用多变量逻辑回归调整协变量后，将血糖异常组与正常筛查组的产妇和新生儿结局进行比较。
在 1713 名肥胖女性中，1418 名（82.8%）1 小时葡萄糖筛查正常，125 名（7.3%）诊断性 3 小时 OGTT 正常，72 名（4.2%）诊断性 OGTT 出现 1 个异常值，98 名（5.7%）被诊断为 GDM。1 个异常值组的巨大儿（LGA）新生儿（调整后的优势比[aOR] = 2.24，95%置信区间[CI]：1.31-3.82）、剖宫产（aOR = 2.19，95% CI：1.34-3.58）和妊娠高血压疾病（aOR = 2.19，95% CI：1.32-3.63）的风险增加，与正常筛查相比。1 个异常值组还增加了早产<37 周（aOR = 2.63，95% CI：1.43-4.84）、新生儿呼吸支持（aOR = 2.38，95% CI：1.23-4.60）和新生儿高胆红素血症（aOR = 2.00，95% CI：1.08-3.71）的风险。1 个异常值与肩难产和新生儿低血糖之间没有关联。
对于肥胖女性，3 小时 OGTT 出现 1 个异常值会增加围产期不良结局。这些女性应进一步研究，以确定即使没有 GDM 诊断，营养咨询和更密切的胎儿监测是否能改善结局。
· 对 OGTT 出现 1 个异常值的肥胖女性进行研究。
· 发现了不良的母婴结局，包括更多的 LGA 新生儿。
· 新生儿低血糖的风险没有增加。
