Are non-diabetic women with abnormal glucose screening test at increased risk of pre-eclampsia, macrosomia and caesarian birth?

ABSTRACT

To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test [GCT] on their first visit [usually at 16-20 weeks]; those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks. In 482 cases the GCT was abnormal [plasma glucose value was > 140 mg percent 2 hours after 75 g glucose challenge]. Of these, 292 had one or more abnormal critical values at a 75g - 3 hour oral glucose tolerance test [GTT] and they were treated to maintain euglycaemia. The rest [n=190] had no evidence of glucose intolerance with no abnormal values at the GTT. The subjects were divided into 3 groups based on GCT values; A, randomly selected subjects with a normal GCT [n=1000]; B, those with abnormal GCT but normal GTT [n=190]; and C, those with abnormal GTT [n=292]. The variables studied were age, gravidity, parity, gestational age at delivery, pre-eclampsia, birth-weight and mode of delivery. The incidence of pre-eclampsia and caesarian birth varied, being the lowest in Group A [3.9% and 11.9% respectively] and then rising through group B [6.3% and 16.3% respectively] to the highest in Group C [12.6% and 26.0% respectively; test of linear trend, p<0.05]. For macrosomia, the incidence increased from Group A to B but there was a drop in Group C. The incidence of macrosomia was significantly higher for Group B as compared to A or C [9.5% and 3.3%, p<0.05]. These data show higher risk of complications associated with minor degrees of glucose intolerance emphasizing the need for vigilance in these patients