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Hyperglycemia Without Diabetes Linked to High Birth Weight

Posted: Thursday, May 22, 2008

The presence of hyperglycemia in pregnancy below levels diagnostic for diabetes is associated with an increased risk for several negative pregnancy outcomes, according to new research.

Researchers forming the HAPO Study Cooperative Research Group conducted oral glucose testing in 25,505 women who were 24 to 32 weeks pregnant and attending any of 15 participating centers in nine countries. The results remained blinded for women with fasting plasma glucose levels of 105 mg/dL (5.8 mmol/L) or less and with 2-hour plasma glucose of 200 mg/dL (11.1 mmol/L) or less.

Overall, data on 23,316 women remained blinded. Among those who had infants with a birth weight above the 90th percentile, the adjusted odds ratio (OR) of having a fasting plasma glucose level 1 standard deviation (SD) above the mean was 1.38, the OR for having a 1-hour plasma glucose 1 SD above the mean was 1.46, and the OR of having a similarly elevated 2-hour plasma glucose was 1.38. Similarly, women with cord-blood serum C-peptide levels above the 90th percentile had an OR of 1.55 for elevated fasting glucose, an OR of 1.46 for elevated 1-hour glucose, and an OR of 1.37 for elevated 2-hour glucose. Less strong associations were also observed between hyperglycemia and primary caesarian delivery as well as neonatal hypoglycemia.

This research highlights the risks associated with hyperglycemia in pregnancy even when it remains in the nondiabetic range. No clear glucose threshold at which risks become particularly elevated has yet been identified.

Here are some recommendations for detecting gestational diabetes from the American Diabetes Association:

• Screen for diabetes in pregnancy using risk factor analysis and, if appropriate, use of an oral glucose tolerance test (OGTT).

• Screen women with gestational diabetes mellitus for diabetes 6 to 12 weeks postpartum and follow them up with subsequent screening for the development of diabetes or pre-diabetes

• Women with clinical characteristics consistent with a high risk for gestational diabetes mellitus should undergo glucose testing as soon as possible. High-risk women not found to have gestational diabetes mellitus at the initial screening and average-risk women should be tested between 24 and 28 weeks of gestation.

Source: Diabetes In Control: New England Journal of Medicine, May 2008