Comparison of Obstetric and Neonatal Outcomes According to Oral Glucose Challenge Test in Korean Pregnant Women

Sung Hyun Yun; Sang Won Han; San Hui Lee; Yong Wook Jung; Euy Hyuk Kim

doi:10.14734/kjp.2013.24.3.180

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Yun, Han, Lee, Jung, and Kim: Comparison of Obstetric and Neonatal Outcomes According to Oral Glucose Challenge Test in Korean Pregnant Women

Original Article

Korean J Perinatol 2013;24(3):180-186.

Published online: 19 June 2013

DOI: https://doi.org/10.14734/kjp.2013.24.3.180

Comparison of Obstetric and Neonatal Outcomes According to Oral Glucose Challenge Test in Korean Pregnant Women

Sung Hyun Yun¹, Sang Won Han¹, San Hui Lee¹, Yong Wook Jung², Euy Hyuk Kim^1,

¹Department of Obstetrics and Gynecology, National Health Insurance Corporation Ilsan Hospital, Goyang-si, Korea

²Department of Obstetrics and Gynecology, School of Medicine, CHA University, CHA Gangnam Medical Center, Seoul, Korea

주관책임자 : 김의혁, 410-719 경기도 일산동구 백석동 1232번지 국민건강보험공단 일산병원 산부인과 전화 : 031)900-0211, 전송 : 031)900-0138 E-mail : raksumi10@gmail.com

이 연구는 건강관리공단 일산병원에서 연구비를 지원 받아 이루어졌음.

Received 29 June 2013 Revised 24 August 2013 Accepted 1 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose :

The purpose of the study was to compare obstetric and perinatal outcomes according to glucose challenge test (GCT) in a single institution.

Methods :

One thousand six women, who were underwent antepartum gestational diabetes mellitus (GDM) screening by a GCT in mid-pregnancy and delivered at National Health Service between January 1, 2007 and July 31, 2012, were included in the study. The medical records of patients were analyzed retrospectively. The Subjects were categorized into three groups according to the results of 50 g oral GTC and 100 g oral GTC; normal glucose tolerance (NGT, n=826), less than 140 mg/dL; gestational impaired glucose tolerance (GIGT, n=128), more than 140 mg/dL but non-GDM; gestational diabetes mellitus (GDM, n=52). Pre-existed maternal DM or hypertension and twin pregnancy were excluded. Obstetric and perinatal outcomes were compared among the three groups.

Result :

Maternal age, parity, and pre-pregnancy body mass index were higher in the GDM. The preterm delivery and gestational hypertension increased across the groups from NGT to GIGT to GDM (13.9% vs. 18.8% vs. 25.0%, P<0.01, and 1.9% vs.5.5% vs. 13.5%, P<0.01, respectively). Large for gestational age (LGA) and Neonatal Intensive Care Unit admission rate were higher in order in NGT, GIGT, and GDM (6.2% vs. 15.6% vs. 15.4%, P<0.01, and 12.3% vs. 24.2% vs. 38.5%, P<0.01), but other complications requiring intensive care were not different among the groups, including meconium aspiration syndrome and birth asphyxia.

Conclusion :

GDM was a risk factor of cesarean section, preterm delivery, and gestational hypertension. In addition, GIGT was positively correlated with gestational hypertension, preterm labor, cesarean section rate, and LGA. This study suggests that there is a need to develop a guideline for Korean pregnant women who were diagnosed with GIGT.

Keywords: Gestational diabetes mellitus, Glucose challenge test, Pregnancy outcomes

REFERENCES

1). Metzger BE., Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998. 21(Suppl 2):B161–7.

2). American Diabetes Association: Gestational diabetes mellitus. Diabetes Care. 2000. 23(Suppl1):77–9.

3). Moore TR. Diabetes in pregnancy. Creasy RK, Resnik R, Iams JD, editors. editors.Maternal-Fetal medicine. Principles and practice. 5th ed.Philadelphia: Saunders;2004. p. 1023–61.

4). Narayan KM., Boyle JP., Thompson TJ., Sorensen SW., Williamson DF. Lifetime risk for diabetes mellitus in the United States. JAMA. 2003. 290:1884–90.

5). Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979. 28:1039–57.

6). Crowther CA., Hiller JE., Moss JR., McPhee AJ., Jeffries WS., Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005. 352:2477–86.

7). Sheffield JS., Butler-Koster EL., Casey BM., McIntire DD., Leveno KJ. Maternal diabetes mellitus and infant malformations. Obstet Gynecol. 2002. 100:925–30.

8). Silverman BL., Rizzo TA., Cho NH., Metzger BE. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care. 1998. 21(Suppl 2):B142–9.

9). Lobner K., Knopff A., Baumgarten A., Mollenhauer U., Ma-rienfeld S., Garrido-Franco M, et al. Predictors of postpartum diabetes in women with gestational diabetes. Diabetes. 2006. 55:792–70.

10). Kjos SL., Buchanan TA. Gestational diabetes mellitus. N Engl J Med. 1999. 341:1749–56.

11). Kang HJ., Kwak HM., Kim YS., Park JS., Yoon G., Oh SY, et al. Obstetric and neonatal outcomes after treatment of gestational diabetes mellitus class A1 and class A2. Korean J Obstet Gynecol. 2010. 53:681–6.

12). Sim KS., Lee HS., Bai JW., Cha SH., Jung SJ. A Clinical observation on infants of diabetic mother. Kor J Perinatol. 1995. 6:421–8.

13). Kim SH., Kim PS., Yuk JS., Oh SO., Park CH., Hong SY, et al. Comparative study of maternal and perinatal complications in overt and gestational diabetes. Kor J Perinatol. 2004. 15:274–80.

14). Retnakaran R., Qi Y., Connelly PW., Sermer M., Zinman B., Hanley AJ. Glucose intolerance in pregnancy and postpartum risk of metabolic syndrome in young women, J Clin Endocrinol Metab. 2010. 95:670–7.

15). Retnakaran R., Qi Y., Sermer M., Connelly PW., Hanley AJ., Zinman B. Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care. 2008. 31:2026–31.

16). Seo K., Park YW., Park CK. Birthweight distribution by gestational age and constructing cut off value for fetal growth retardation (FGR); their statistical consideration. Korean J Obstet Gynecol. 1989. 32:530–40.

17). Lucas MJ., Lowe TW., Bowe L., McIntire DD. Class A1 gestational diabetes: a meaningful diagnosis? Obstet Gynecol. 1993. 82:260–5.

18). Sheffield JS., Butler-Koster EL., Casey BM., McIntire DD., Leveno KJ. Maternal diabetes mellitus and infant malformations. Obstet Gynecol. 2002. 100:925–30.

19). Metzger BE., Coustan DM. Organizing committee: summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus. Diabetes Care. 1998.

20). Ryu JW., Rho YH., Han SW., Ha HY., Kim EH. The pros and cons of different modes of delivery at a single institution. Korean J Obstet Gynecol. 2011. 54:279–85.

21). Werner EF., Savitz DA., Janevic TM., Ehsanipoor RM., Thung SF., Funai EF, et al. Mode of delivery and neonatal outcomes in preterm, small-for-gestational-age newborns. Obstet Gynecol. 2012. 120:560–4.

22). Caren GS., Steven WG., Michael FG., Ellen WS. Glucose intolerance as a predictor of hypertension in pregnancy. Hypertension. 1994. 23:717–21.

23). Johnson SR., Kolberg BH., Vance MW., Railsback LD. Maternal obesity and pregnancy. Surg Gynecol Obstet. 1987. 164:431–7.

24). Ehrenberg HM., Mercer BM., Catalano PM. The influence of obesity and diabetes on the prevalence of macrosomia. Am J Obstet Gynecol. 2004. 191:964–8.

25). Turok DK., Ratcliffe SD., Baxley AG. Management of gestational diabetes mellitus. Am Fam Physician. 2003. 68:1769–72.

26). Xiang AH., Peters RK., Trigo E., Kjos SL., Lee WP., Buchanan TA. Multiple metabolic defects during late pregnancy in women at high risk for type 2 diabetes mellitus. Diabetes. 1999. 48:848–54.

27). Catalano PM., Huston L., Amini SB., Kalhan SC. Longitudinal changes in glucose metabolism during pregnancy in obese women with normal glucose tolerance and gestational diabetes. Am J Obstet Gynecol. 1999. 180:903–16.

28). Oded L., Yariv Y., Elly MJ., Loid B. Overweight and obese in gestational diabetes: The impact on pregnancy outcome. Am J Obstet Gynecol. 2005. 192:1768–76.

Table 1.

Subject Characteristics of Pregnant Women According to OGTT

	NGT (n= 826)	140 ≤		P-value
	NGT (n= 826)	GIGT (n=128)	GDM (n=52)	P-value
Age (yrs)	32.2±4.5	32.9±4.1∗	34.1±4.2∗	<0.01
Parity	0.7±0.8	0.8±0.8∗	1.1±0.8∗	<0.01
Pre-pregnant BMI(kg/m²)	21.5±3.1	21.7±3.4	23.6±4.8∗^†	<0.01
Gestational Age (Weeks)	38.0±2.2	37.5±4.0∗	37.2±1.6∗	<0.01
Weight gain(kg)	13.4±4.7	13.1±4.8	12.0±7.1	0.1
50 g OGTT	109.9±15.8	152.8±11.9∗	165.8±21.2∗^†	<0.01
Overall C/S rate	359 (43.5%)	59 (46.1%)	36 (69.2%)∗^†	<0.01
Primigravida C/S rate	38.1% (139/365)	44.2% (23/52)	80.0%∗^† (12/15)	<0.01
Multiparity	460 (55.7%)	76 (59.4%)	37 (71.2%)∗^†	0.02
HbA1c		5.3±0.3	5.7±0.5^†	<0.01
Preterm delivery <34 weeks	21 (2.5%)	7 (5.5%)	1 (1.9%)	0.411
Preterm delivery <37 weeks	115 (13.9%)	24 (18.8%)∗	13 (25.0%)∗^†	0.01
Hypertensive disorders	16 (1.9%)	7 (5.5%)∗	7 (13.5%)∗^†	<0.01
BMI > 25(kg/m²)	97 (11.7%)	19 (14.8%)∗	15 (28.8%)∗^†	<0.01

Data are presented as n (%) or mean±SD. Abbreviations: OGTT, oral glucose tolerance test; NGT, normal glucose tolerance; GIGT, gestational impaired gluco tolerance; GDM, gestational diabetes mellitus; BMI, body mass index; C/S, cesarean section. ∗P< 0.05 vs. NGT,

^† P< 0.05 vs. GIGT.

Table 2.

Neonatal Outcomes According to the Groups

	NGT (n=826)	140 ≤		P-value
	NGT (n=826)	GIGT (n=128)	GDM (n=52)	P-value
Baby weight (g)	3,096±468	3,069±566	3,036.6±492	0.5
Apgar score
1 minute	6.9±1.0	6.8±1.0	6.7±0.9	0.17
5 minute	8.0±0.9	7.9±8.3	8.0±0.7	0.84
LGA	51 (6.2%)	20 (15.6%)∗	8 (15.4%)∗^†	<0.01
SGA	85 (10.3%)	16 (12.5%)	6 (5.2%)	0.52
NICU admission	102 (12.3%)	31 (24.2%)	20 (38.5%)∗^†	<0.01

Data are presented as n (%) or mean±SD. Abbreviations: NGT, normal glucose tolerance; GIGT, gestational impaired glucose tolerance; GDM, gestational diabetes mellitus; LGA, large for gestational age; SGA, small for gestational age; NICU, neonatal intensive care unit. ∗P<0.05 vs. NGT,

^† P<0.05 vs. GIGT.

Table 3.

Characteristics of Neonatal Outcomes (2)

	NGT (n=826)	140 ≤		P-value
	NGT (n=826)	GIGT (n=128)	GDM (n=52)	P-value
Meconium aspiration	61 (7.4%)	5 (3.9%)	3 (5.8%)	0.24
Intubation	29 (3.5%)	6 (4.7%)	2 (3.9%)	0.62
Skull fracture/brain damage	10 (1.2%)	2 (1.6%)	0	0.67
Clavicle fracture	4 (0.5%)	0	1 (1.9%)	0.47
Birth asphyxia	12 (1.5%)	1 (0.8%)	1 (1.9%)	0.90

Data are presented as n (%). Abbreviations: NGT, normal glucose tolerance; GIGT, gestational impaired glucose tolerance; GDM, gestational diabetes mellitus.

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