Are non-diabetic women with abnormal glucose screening test at increased risk of pre-eclampsia, macrosomia and caesarian birth?
To determine, in non-diabetic women, the relationship of abnormal glucose screening test, with the incidence of pre-eclampsia, macrosomia and caesarian delivery, from 1988-92, 5646 consecutive women attending antenatal clinic were screened with a glucose challenge test (GCT) on their first visit (usually at 16-20 weeks); those with risk factors i.e., history of unexplained perinatal loss, macrosomia or family member with diabetes and an initial abnormal screening test were rescreened at 28-32 weeks. In 482 cases the GCT was abnormal (plasma glucose value was > 140 mg% 2 hours after 75 g glucose challenge). Of these, 292 had one or more abnormal critical values at a 75 g-3 hour oral glucose tolerance test (GTT) and they were treated to maintain euglycaemia. The rest (n = 190) had no evidence of glucose intolerance with no abnormal values at the GTT. The subjects were divided into 3 groups based on GCT values; A, randomly selected subjects with a normal GCT (n = 1000); B, those with abnormal GCT but normal GTT (n = 190); and C, those with abnormal GTT (n = 292). The variables studied were age, gravidity, parity, gestational age at delivery, pre-eclampsia, birth-weight and mode of delivery. The incidence of pre-eclampsia and caesarian birth varied, being the lowest in Group A (3.9% and 11.9% respectively) and then rising through group B (6.3% and 16.3% respectively) to the highest in Group C (12.6% and 26.0% respectively; test of linear trend, p < 0.05). For macrosomia, the incidence increased from Group A to B but there was a drop in Group C.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Obstetrics and Gynaecology, Aga Khan University Medical Centre, Karachi.
K S
KS
Khan
F A
FA
Hashmi
J H
JH
Rizvi
D000328:Adult; D000704:Analysis of Variance; D002585:Cesarean Section; D016009:Chi-Square Distribution; D005260:Female; D005320:Fetal Macrosomia / Q000097:blood / Q000517:prevention & control*; D005951:Glucose Tolerance Test / Q000379:methods; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D016014:Linear Models; D010154:Pakistan / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000097:blood / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000517:prevention & control*; D012680:Sensitivity and Specificity