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Abstract
Purpose
The aim of the study is to determine whether late preterm infants from normal oral GTT (glucose tolerance test) but positive GCT (glucose challenge test) mothers are associated with adverse postnatal outcome.
Methods
A retrospective study was performed from singleton infants who were born at 34+0–36+6 weeks between January 2008 and December 2012 and prenatally checked at CHA Gangnam Medical Center. Infants were categorized into three groups according to the results of 50 g oral GCT and 100 g oral GTT; NG group (normal glucose tolerance group, n=603) vs. GIG group (gestational impaired glucose tolerance group; infants of normal oral GTT but positive GCT mothers, n=77) vs. GDM group (gestational diabetes group, n=52). Neonatal outcomes were compared among the three groups.
Results
GIG group showed significantly increased incidence of jaundice compared to NG group (9.6% vs. 19.5%, P=0.031). The number of old mothers (≥35 years at delivery) was significantly higher in GIG group compared to NG group (27.5% vs. 33.8%, P=0.006). After stratification by maternal age, GIG group showed significantly increased respiratory diseases compared to NG group (44% vs. 65.4%, P=0.04). Hypocalcemia and feeding problem increased across the groups (NG vs. GIG vs. GDM; 13.3% vs. 26.9% vs. 32.0%, P= 0.024; 6.0% vs. 11.5% vs. 20.0%, P=0.05, respectively).
Conclusion
Late preterm infants of normal oral GTT but positive GCT mothers, especially in older mother, have increased risk of postnatal morbidities such as respiratory distress, jaundice, hypocalcemia or feeding intolerance. Thus, careful follow up may be needed in this group since antepartum period.
References
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Table 1.
Main Causes of Preterm Delivery
| NG group (n=603) | GIG group (n=77) | GDM group (n=52) | P value | |
|---|---|---|---|---|
| PIH | 67 (11.1%) | 6 (7.8%) | 12 (23.1%) | 0.019∗ |
| Placental bleeding | 34 (5.6%) | 4 (5.2%) | 0 (0%) | 0.213 |
| PPROM | 257 (42.6%) | 43 (55.8%) | 16 (30.8%) | 0.015∗ |
| Preterm labor only | 216 (35.8%) | 22 (28.6%) | 22 (42.3%) | 0.260 |
| Combined fetal distress | 24 (4.0%) | 2 (2.6%) | 0 (0%) | 0.295 |
| Maternal medical problems | 5 (0.8%) | 0 (0%) | 2 (3.8%) | 0.066 |
Table 2.
Clinical Characteristics between Groups
| NG group (n=603) | GIG group (n=77) | GDM group (n=52) | P value | |
|---|---|---|---|---|
| Maternal age (years) | 32.3±4.2 | 32.8±4.1 | 34.7±3.7 | 0.000∗ |
| ≥35 years at delivery | 166 (27.5%) | 26 (33.8%) | 25 (28.8%) | 0.006∗ |
| Admission duration (days) | 8.6±6.0 | 8.7±6.6 | 9.0±6.1 | 0.888 |
| Gestational age (weeks) | 35.9±0.8 | 35.8±0.8 | 35.9±0.9 | 0.674 |
| Birth weight (g) | 2,595±386 | 2,620±399 | 2,827±550 | 0.000∗ |
| SGA | 63 (10.4%) | 4 (5.3%) | 2 (3.8%) | 0.120 |
| LGA | 9 (1.5%) | 2 (2.7%) | 10 (20%) | 0.000∗ |
| Male infants | 341 (56.6%) | 46 (59.7%) | 32 (61.5%) | 0.702 |
| C-section | 296 (49.1%) | 26 (33.8%) | 24 (46.2%) | 0.040∗ |
| Apgar score (1 min) | 7.3±0.9 | 7.3±0.9 | 7.0±1.0 | 0.077 |
| Apgar score (5 min) | 8.5±0.8 | 8.6±0.6 | 8.4±0.8 | 0.300 |
| Total respiratory morbidity | 256 (42.5%) | 35 (45.5%) | 30 (57.7%) | 0.100 |
| Apnea | 54 (9.0%) | 11 (14.3%) | 6 (11.5%) | 0.567 |
| TTN | 175 (29.0%) | 20 (26.0%) | 18 (34.6%) | 0.299 |
| RDS | 57 (9.5%) | 8 (10.4%) | 10 (19.2%) | 0.083 |
| Extrapulmonary air leaks | 9 (1.5%) | 1 (1.3%) | 0 (0%) | 0.672 |
| Sepsis | 25 (4.1%) | 4 (5.1%) | 4 (7.7%) | 0.474 |
| Jaundice | 58 (9.6%) | 15 (19.5%) | 6 (11.5%) | 0.031∗ |
| Hypoglycemia | 11 (1.8%) | 1 (1.3%) | 0 (0%) | 0.592 |
| Hypocalcemia | 92 (15.3%) | 14 (18.2%) | 14 (26.9%) | 0.084 |
| Feeding intolerance | 25 (4.1%) | 6 (7.8%) | 7 (13.5%) | 0.008∗ |
| Heart anomaly | 29 (4.8%) | 4 (5.2%) | 8 (11.5%) | 0.116 |
| Other anomaly | 7 (1.2%) | 3 (3.9%) | 4 (7.7%) | 0.002∗ |
Table 3.
Stratified Analysis by Maternal Age at Delivery
| Old aged mothers | NG group (≥35 years at delivery) | GIG group (n=166) | GDM group (n=26) | P value (n=25) |
|---|---|---|---|---|
| Maternal age (years) | 37.3±2.3 | 37.2±2.3 | 37.5±2.4 | 0.907 |
| Gestational age (weeks) | 35.9±0.8 | 35.6±0.9 | 35.8±0.9 | 0.278 |
| Birth weight (g) | 2,620±435 | 2,606±468 | 2,974±557 | 0.001∗ |
| Male infants | 98 (59.0%) | 16 (61.5%) | 17 (68.0%) | 0.688 |
| C-section | 101 (60.8%) | 14 (53.8%) | 13 (52.0%) | 0.599 |
| Total respiratory morbidity | 73 (44.0%) | 17 (65.4%) | 16 (64.0%) | 0.035∗ |
| Apnea | 16 (9.6%) | 5 (19.2%) | 2 (8.0%) | 0.304 |
| TTN | 49 (29.5%) | 11 (42.3%) | 10 (40.0%) | 0.293 |
| RDS | 18 (10.8%) | 3 (11.5%) | 6 (24.0%) | 0.176 |
| Jaundice | 20 (12.0%) | 7 (26.9%) | 2 (8.0%) | 0.082 |
| Hypocalcemia | 22 (13.3%) | 7 (26.9%) | 8 (32.0%) | 0.024∗ |
| Feeding intolerance | 10 (6.0%) | 3 (11.5%) | 5 (20.0%) | 0.050∗ |
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