Alison M Stuebe1, Mark B Landon2, Yinglei Lai3, Mark Klebanoff4, Susan M Ramin5, Ronald J Wapner6, Michael W Varner7, Dwight J Rouse8, Anthony Sciscione9, Patrick Catalano10, George Saade11, Yoram Sorokin12, Alan M Peaceman13. 1. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio. 3. George Washington University Biostatistics Center, Washington, District of Columbia. 4. Nationwide Children's Hospital, Columbus, Ohio. 5. The University of Texas Health Science Center at Houston, Houston, Texas. 6. Department of Obstetrics and Gynecology, Columbia University, New York, New York. 7. Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah. 8. University of Alabama at Birmingham, Birmingham, Alabama. 9. Drexel University, Philadelphia, Pennsylvania. 10. Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio. 11. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. 12. Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan. 13. Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Abstract
OBJECTIVE: This study aims to determine whether there is a threshold 3-hour oral glucose tolerance test (OGTT) value associated with accelerated risk of adverse pregnancy outcomes. STUDY DESIGN: In a secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, we used generalized additive models with smoothing splines to explore nonlinear associations between each of the 3-hour OGTT values (fasting, 1-hour, 2-hour, and 3-hour) and adverse pregnancy outcomes, including the study's composite outcome (perinatal mortality, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/or birth trauma), large for gestational age birth weight, small for gestational age birth weight, shoulder dystocia, neonatal hypoglycemia, gestational hypertension (gHTN), and preeclampsia. RESULTS: Among the 1,360 eligible women, each timed OGTT value was linearly associated with increased odds of composite adverse outcome. We found evidence of a departure from linearity only for the association between fasting glucose and gHTN/preeclampsia, with a stronger association for values of 85 to 94 mg/dL (p = 0.03). We found no evidence of departure from linearity for any other OGTT values and measured outcomes (all chi-square test p-values ≥ 0.05). CONCLUSION: In a population of untreated women with mild gestational glucose intolerance and fasting OGTT < 95 mg/dL, we found an increasing risk of gHTN with a fasting glucose between 85 and 94 mg/dL. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
RCT Entities:
OBJECTIVE: This study aims to determine whether there is a threshold 3-hour oral glucose tolerance test (OGTT) value associated with accelerated risk of adverse pregnancy outcomes. STUDY DESIGN: In a secondary analysis of a cohort of women with untreated mild gestational glucose intolerance, we used generalized additive models with smoothing splines to explore nonlinear associations between each of the 3-hour OGTT values (fasting, 1-hour, 2-hour, and 3-hour) and adverse pregnancy outcomes, including the study's composite outcome (perinatal mortality, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and/or birth trauma), large for gestational age birth weight, small for gestational age birth weight, shoulder dystocia, neonatal hypoglycemia, gestational hypertension (gHTN), and preeclampsia. RESULTS: Among the 1,360 eligible women, each timed OGTT value was linearly associated with increased odds of composite adverse outcome. We found evidence of a departure from linearity only for the association between fasting glucose and gHTN/preeclampsia, with a stronger association for values of 85 to 94 mg/dL (p = 0.03). We found no evidence of departure from linearity for any other OGTT values and measured outcomes (all chi-square test p-values ≥ 0.05). CONCLUSION: In a population of untreated women with mild gestational glucose intolerance and fasting OGTT < 95 mg/dL, we found an increasing risk of gHTN with a fasting glucose between 85 and 94 mg/dL. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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