Risk of Adverse Perinatal Outcomes in African American Women With One Elevated 3-Hour Oral Glucose Tolerance Test Value [329

Abstract

INTRODUCTION: The importance of screening for gestational diabetes has been well studied; however, the significance of one abnormal value in a 3-hour glucose tolerance test remains controversial. The objective was to examine whether African American women with one abnormal glucose tolerance test value are at increased risk for adverse perinatal outcomes compared with women who screened negative. METHODS: A retrospective chart review was performed assessing singleton pregnancies in African American women between January and August 2014 at State University of New York Downstate Medical Center. Perinatal outcomes measured included: cord pH, Apgar scores, birth weights, and delivery mode. Exclusion criteria included multiple gestation, pregestational diabetes mellitus, maternal comorbidities including hypertension, autoimmune disease, cancer, morbid obesity, hypercholesterolemia, hypertriglyceridemia, heart disease, lung disease, and renal failure diagnosed before pregnancy. Fisher's exact test was used with a P value of <.05 indicating statistical significance. RESULTS: Of 386 patients, 56 had one elevated glucose tolerance test value and 330 were in the comparison group. Women with one elevated glucose tolerance test value had a higher rates of cesarean delivery (P<.01), birth weight greater than 4,000 g (P<.001), and greater than 4,500 g (P<.05). There were no significant differences in 5-minute Apgar scores (P<.30) or cord pH (P<.22). CONCLUSION: In the African American population served by this institution, it appears that although women with one positive glucose tolerance test value do not meet strict criteria for a diagnosis of gestational diabetes, they are still at risk for higher rates of operative delivery and fetal birth weights.