Does mild hyperglycemia in 75gm Glucose Tolerance Test (GTT) affect outcome in pregnant women?
Keywords:GDM, Glucose tolerance test, Hyperglycemia in pregnancy, Impaired glucose tolerance, Large for gestational age (LGA) babies
Background: Glucose tolerance in pregnancy is fundamentally linked to fetal growth. The relationship between maternal glycemia and adverse outcomes is a continuous process, with no distinct cut off point for increased risk. The objective of the study is to find out whether mild hyperglycemia in 2 hour 75 gm Glucose Tolerance Test (GTT) affects maternal and perinatal outcome in pregnant women.
Methods: This case control study was conducted in SRM Medical College during a 10-month period. Mild hyperglycemia was diagnosed when the - 2hour non- fasting 75gm GTT was between 120-139 mg/dl and Controls were women with 2hour nonfasting 75gm GTT <120mg/dl. Maternal and neonatal parameters were noted and the results were compared.
Results: During the study period 142 delivered women had mild hyperglycemia, of which 10 patients on subsequent blood sugar monitoring required insulin for blood sugar control. There was significant family history of diabetes in women with mild hyperglycemia when compared to controls. There was no significant difference in incidence of hypertension, hypothyroidism, preterm delivery and caesarean section between the two groups. LGA (Large for gestational age babies) (p=0.001) and serum triglyceride levels (p=0.04) were significantly more in women with mild hyperglycemia when compared to controls.Conclusions: Mild hyperglycemia during pregnancy should not be ignored and periodic blood sugar monitoring should be done to improve maternal and fetal outcome.
Sermer M, Naylor CD, Farine D, Kenshole AB, Ritchie JW, Gare DJ et al. The Toronto Tri-Hospital gestational diabetes project: A preliminary review. Diabetes Care. 1998 Aug;21 Suppl 2:B33-42.
Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol. 1954;16:330-42.
Jovanovic-Peterson L, Peterson CM, Reed GF, Metzger BE, Mills JL, Knopp RH, et al. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development–Diabetes in Early Pregnancy Study. Am J Obstet Gynecol. 1991;164:103-11.
Scholl TO, Sowers M, Chen X, Lenders C. Maternal glucose concentration influences fetal growth, gestation, and pregnancy complications. Am J Epidemiol. 2001;154 (6): 514-520.
Seshiah V, Balaji V, Balaji S, Sekar A, Sanjeevi CB, Green A. One step screening procedure for screening and diagnosis of gestational diabetes mellitus. J Obstet Gynecol India. 2005;55(6):525-9.
HAPO Study Cooperative Research Group. The hyperglycemia and adverse pregnancy outcome (HAPO) study. Intl J Gynaecol Obstet. 2002;78:69-77
Berghaus TM, Demmelmair H, Koletzko B. Fatty acid composition of lipid classes in maternal and cord plasma at birth. Eur J Pediatr. 1998;157:763-8.
Schaefer-Graf UM, Graf K, Kulbacka I, Kjos SL, Dudenhausen J, Vetter K, et al. Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care. 2008;31:1858-63.
Chen X, Scholl TO, Leskiw M, Savaille J, Stein TP. Differences in maternal circulating fatty acid composition and dietary fat intake in women with gestational diabetes mellitus or mild gestational hyperglycemia. Diabetes Care. 2010;33(9):2049-54.
Wei J, Gao J, Cheng J. Gestational diabetes mellitus and impaired glucose tolerance pregnant women. Pak J Med Sci. 2014 Nov-Dec;30(6):1203-8.