Using the 100-g oral glucose tolerance test to predict fetal and maternal outcomes in women with gestational diabetes mellitus.

BACKGROUND: This 5-year cohort study investigated gestational diabetes mellitus (GDM) using new diagnostic criteria and predictive factors for maternal and fetal outcomes. METHODS: From March 2001 to February 2006, 8557 pregnant women underwent a 50-g glucose challenge test (GCT) at 24 to 28 weeks of gestation. A diagnosis of GDM was based on a a one-hour plasma glucose level >/= 140 mg/dl on the 50 g GCT, followed by at lease two abnormal values on a 100-g oral glucose tolerance test (OGTT), according to the Carpenter and Coustan modification of the National Diabetes Data Group (NDDG) criteria. Maternal and fetal outcomes were compared with women with normal glucose tolerance (NGT). RESULTS: The incidence of GDM was 7.4%. After excluding women with twin pregnancies, 617 women with GDM and 1250 women with NGT were enrolled for comparison. Older age (33.7 +/- 4.1 vs. 32.2 +/- 4.1, p < 0.001), lower weight gain during pregnancy (13.2 +/- 4.4 vs. 14.6 +/- 4.0 kg, p < 0.001), and higher rates of caesarean section (43.8% vs. 32.7%, p < 0.001) occurred in women with GDM compared to those in the NGT group. The rates of macrosomia and neonatal death were higher in the GDM group than the NGT group (7.0% vs. 1.9%, p < 0.001 and 0.6% vs. 0.0%, p = 0.005 respectively). The fasting glucose on the 100-g OGTT was positively correlated with birth weight in the GDM group (r = 0.117, 95% CI 0.038-0.194, p = 0.004). A value exceeding 90 mg/dl was 80% sensitive and 50% specific for macrosomia. CONCLUSIONS: The incidence of GDM in Taiwan is increasing more than before based on current diagnostic criteria. The fasting glucose on the 100-g OGTT correlates closely with birth weight and is also an independent risk factor for macrosomia. Focusing on women with fasting blood glucose concentrations > 90 mg/dL is anticipated to improve outcomes effectively.

The postpartum metabolic outcome of women with previous gestational diabetes mellitus.

BACKGROUND: This study investigated postpartum metabolic abnormality in women with previous gestational diabetes mellitus (GDM) and predictive factors for postpartum glucose intolerance. METHODS: From March 2001 to February 2003, 127 prior-GDM women underwent a 75g oral glucose tolerance test (OGTT) and metabolic assessment at least six weeks after delivery. To identify the predictors, clinical variables obtained at the time of GDM were compared. RESULTS: The cumulative incidence rates of diabetes mellitus (DM) and abnormal glucose tolerance (AGT) i.e. impaired fasting glucose or impaired glucose tolerance, in women with previous GDM were 13.4% and 29.1%, respectively. Postpartum body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, blood pressure, waist-to-hip ratio and fasting C-peptide were not significantly different among DM, AGT and normal glucose tolerance (NGT) women. However, the C-peptide/glucose score was lower in DM than in AGT and NGT women (p < 0.01). DM or AGT women had higher prepregnancy BMI and fasting glucose level for 100g OGTT than NGT women (p < 0.05) at the time of GDM. The fasting glucose value was an independent risk factor. The cutoff point of three abnormal values in 100g OGTT provided 86% sensitivity and 43% specificity for the prediction of postpartum DM or AGT. CONCLUSIONS: High prepregnancy BMI and increased glycemic deterioration at the time of GDM are found in women developing postpartum DM and AGT. The fasting glucose value for 100g OGTT is an independent risk factor and more than three abnormal glucose values offers good diagnostic efficacy in predicting postpartum glucose intolerance.