Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds,but below the National Diabetes Data Group thresholds for gestational diabetes mellitus,are related to the risk of neonatal macrosomia,hypoglycaemia and hyperbilirubinaemia |
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Authors: | A Ferrara N S Weiss M M Hedderson Jr" target="_blank">C P QuesenberryJr J V Selby I J Ergas T Peng G J Escobar D J Pettitt D A Sacks |
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Institution: | (1) Division of Research, Kaiser Permanente Medical Care Program of Northern California, 2000 Broadway, Oakland, CA 94612, USA;(2) Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA;(3) Sansum Diabetes Research Institute, Santa Barbara, CA, USA;(4) Kaiser Foundation Hospital, Bellflower, CA, USA |
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Abstract: | Aims/hypothesis Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the
diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than
those of the National Diabetes Data Group (NDDG) that have been in use since 1979. We sought to determine the extent to which
infants of women meeting only the ADA criteria for GDM are at increased risk of neonatal complications.
Materials and methods In a multiethnic cohort of 45,245 women who did not meet the NDDG criteria and were not treated for GDM, we conducted nested
case–control studies of three complications of GDM that occurred in their infants: macrosomia (birthweight >4,500 g, n = 494); hypoglycaemia (plasma glucose <2.2 mmo/l, n = 488); and hyperbilirubinaemia (serum bilirubin ≥342 μmol/l (20 mg/dl), n = 578). We compared prenatal glucose levels of the mothers of these infants and mothers of 884 control infants.
Results Women with GDM by ADA criteria only (two or more glucose values exceeding the threshold) had an increased risk of having an
infant with macrosomia (odds ratio OR = 3.40, 95% CI = 1.55–7.43), hypoglycaemia (OR = 2.61, 95% CI = 0.99–6.92) or hyperbilirubinaemia
(OR = 2.22, 95% CI = 0.98–5.04). Glucose levels 1 h after the 100-g glucose challenge that exceeded the ADA threshold were
particularly strongly associated with each complication.
Conclusions/interpretation These results lend support to the ADA recommendations and highlight the importance of the 1-h glucose measurement in a diagnostic
test for GDM. |
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Keywords: | Clinical science and care Complications Epidemiology Human Hypoglycaemia Pregnancy |
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