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Hyperglycemia and adverse pregnancy outcomes.

Abstract

BACKGROUND

It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes.

METHODS

A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia.

RESULTS

For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker.

CONCLUSIONS

Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.

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  • Authors+Show Affiliations

    ,

    Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. bem@northwestern.edu

    , , , , , , , , , , , , ,

    Source

    The New England journal of medicine 358:19 2008 May 08 pg 1991-2002

    MeSH

    Adult
    Blood Glucose
    C-Peptide
    Cesarean Section
    Female
    Fetal Blood
    Fetal Macrosomia
    Glucose Tolerance Test
    Humans
    Hyperglycemia
    Hypoglycemia
    Infant, Newborn
    Odds Ratio
    Pregnancy
    Pregnancy Complications
    Pregnancy Outcome

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    18463375

    Citation

    HAPO Study Cooperative Research Group, et al. "Hyperglycemia and Adverse Pregnancy Outcomes." The New England Journal of Medicine, vol. 358, no. 19, 2008, pp. 1991-2002.
    HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002.
    Metzger, B. E., Lowe, L. P., Dyer, A. R., Trimble, E. R., Chaovarindr, U., Coustan, D. R., ... Sacks, D. A. (2008). Hyperglycemia and adverse pregnancy outcomes. The New England Journal of Medicine, 358(19), pp. 1991-2002. doi:10.1056/NEJMoa0707943.
    HAPO Study Cooperative Research Group, et al. Hyperglycemia and Adverse Pregnancy Outcomes. N Engl J Med. 2008 May 8;358(19):1991-2002. PubMed PMID: 18463375.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Hyperglycemia and adverse pregnancy outcomes. AU - ,, AU - Metzger,Boyd E, AU - Lowe,Lynn P, AU - Dyer,Alan R, AU - Trimble,Elisabeth R, AU - Chaovarindr,Udom, AU - Coustan,Donald R, AU - Hadden,David R, AU - McCance,David R, AU - Hod,Moshe, AU - McIntyre,Harold David, AU - Oats,Jeremy J N, AU - Persson,Bengt, AU - Rogers,Michael S, AU - Sacks,David A, PY - 2008/5/9/pubmed PY - 2008/5/15/medline PY - 2008/5/9/entrez SP - 1991 EP - 2002 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 358 IS - 19 N2 - BACKGROUND: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS: A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS: For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker. CONCLUSIONS: Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels. SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/18463375/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJMoa0707943?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -