Early Versus Routine Oral Glucose Tolerance Test in Women With Intermediate Hyperglycemia at First Prenatal Visit: A Retrospective Cohort Study in China.

Yunzhen Ye,Xiaotian Li,Kaizhou Qin,Jiangnan Wu,Yu Xiong,Xirong Xiao,Qiongjie Zhou

doi:10.3389/fendo.2021.743170

Abstract

Background and ObjectivesIntermediate hyperglycemia in the first half of pregnancy, defined as a fasting plasma glucose level between 5.1- 6.9 mM, increases the risk of gestational diabetes mellitus, but clinical evidence for further management is lacking. We aim to evaluate the effectiveness of an early oral glucose tolerance test (OGTT) followed by the identification of intermediate hyperglycemia on pregnancy outcomes in real world setting.Subjects and MethodsA retrospective cohort study was conducted at the Obstetrics and Gynecology Hospital, Shanghai, China, between 2013 and 2017. Women with intermediate hyperglycemia at the first prenatal visit were identified and underwent an immediate (within one week) or a routine OGTT (24-28 gw) according to their wishes and received nutrition and exercise advice. Women diagnosed of gestational diabetes (GDM) were managed by standard interventions. Primary outcome was larger for gestational age (LGA). Secondary outcomes were primary cesarean delivery, preterm birth, shoulder dystocia or forceps delivery, preeclampsia, neonatal hypoglycemia, hyperbilirubinemia, and low Apgar score. Logistic regressions with or without a further propensity score-matched analysis were performed.ResultsAmong 42406 women involved, 1104 (2.6%) with intermediate hyperglycemia at the first prenatal visit were identified, of whom 176 (15.9%) underwent an early OGTT and 741 (67.1%) received a routine OGTT. Logistic regression showed that an early OGTT was not significantly associated with an altered risk of LGA (adjusted OR 1.13, 95% CI 0.73-1.75) but was related to an increased odds for neonatal hyperbilirubinemia (adjusted OR 2.89; 95% CI 1.55-5.37). No significant associations were observed for other secondary outcomes. These trends remained consistent in propensity score-matched models.ConclusionsOur data from a real-world setting did not support that an early OGTT among women with intermediate hyperglycemia at the first prenatal visit improved pregnancy outcomes.

Highlights

Gestational diabetes mellitus (GDM) is a common complication during pregnancy, affecting 15% of pregnancies worldwide [1]
Logistic regression showed that an early oral glucose tolerance test (OGTT) was not significantly associated with an altered risk of larger for gestational age (LGA) but was related to an increased odds for neonatal hyperbilirubinemia
Our data from a real-world setting did not support that an early OGTT among women with intermediate hyperglycemia at the first prenatal visit improved pregnancy outcomes

Summary

Introduction

Gestational diabetes mellitus (GDM) is a common complication during pregnancy, affecting 15% of pregnancies worldwide [1]. The recommendation of the International Association of Diabetes and Pregnancy Study Group (IAPDSG) for universal screening for GDM after 24 weeks of gestation by a 75 g oral glucose tolerance test (OGTT) is accepted without doubt or controversy [2, 4]. Women with intermediate hyperglycemia at the first prenatal visit should be regarded as being at high risk for GDM, and an early OGTT may help to improve pregnancy outcomes. Intermediate hyperglycemia in the first half of pregnancy, defined as a fasting plasma glucose level between 5.1- 6.9 mM, increases the risk of gestational diabetes mellitus, but clinical evidence for further management is lacking. We aim to evaluate the effectiveness of an early oral glucose tolerance test (OGTT) followed by the identification of intermediate hyperglycemia on pregnancy outcomes in real world setting

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Conclusion