The 75-gram glucose load in pregnancy: relation between glucose levels and anthropometric characteristics of infants born to women with normal glucose metabolism.
OBJECTIVE
To investigate, in pregnant women without gestational diabetes mellitus (GDM), the relation among obstetric/demographic characteristics; fasting, 1-h, and 2-h plasma glucose values resulting from a 75-g glucose load; and the risk of abnormal neonatal anthropometric features and then to verify the presence of a threshold glucose value for a 75-g glucose load above which there is an increased risk for abnormal neonatal anthropometric characteristics.


METHODS
The study group consisted of 829 Caucasian pregnant women with singleton pregnancy who had no history of pregestational diabetes or GDM, who were tested for GDM with a 75-g, 2-h glucose load, used as a glucose challenge test, in two periods of pregnancy (early, 16-20 weeks; late, 26-30 weeks), and who did not meet the criteria for a GDM diagnosis. In the newborns, the following abnormal anthropometric characteristics were considered as outcome measures: cranial/thoracic circumference (CC/TC) ratio </=10th percentile for gestational age (GA), ponderal index (birth weight/length(3) x 100) >/=90th percentile for GA, and macrosomia (birth weight >/=90th percentile for GA), on the basis of growth standard development for our population. For the first part of the objective, logistic regression models were used to identify 75-g glucose load values as well as obstetric and demographic variables as markers for abnormal neonatal anthropometric characteristics. For the second part, the receiver operating characteristic (ROC) curve was performed for the 75-g glucose load values to determine the plasma glucose threshold value that yielded the highest combined sensitivity and specificity for the prediction of abnormal neonatal anthropometric characteristics.


RESULTS
In both early and late periods, maternal age >35 years was a predictor of neonatal CC/TC ratio </=10th percentile and macrosomia, with fasting 75-g glucose load values being independent predictors of neonatal CC/TC ratio </=10th percentile. In both periods, 1-h values gave a strong association with all abnormal neonatal anthropometric characteristics chosen as outcome measures, with maternal age >35 years being an independent predictor for macrosomia. The 2-h, 75-g glucose load values were significantly associated in both periods with neonatal CC/TC ratio </=10th percentile and ponderal index >/=90th percentile, whereas maternal age >35 years was an independent predictor of both neonatal CC/TC ratio </=10th percentile and macrosomia. In the ROC curves for the prediction of neonatal CC/TC ratio </=10th percentile for GA in both early and late periods of pregnancy, inflection points were identified for a 1-h, 75-g glucose load threshold value of 150 mg/dl in the early period and 160 mg/dl in the late period.


CONCLUSIONS
This study documented a significant association, seen even in the early period of pregnancy, between 1-h, 75-g glucose load values and abnormal neonatal anthropometric features, and provided evidence of a threshold relation between 75-g glucose load results and clinical outcome. Our results would therefore suggest the possibility of using a 75-g, 1-h oral glucose load as a single test for the diagnosis of GDM, adopting a threshold value of 150 mg/dl at 16-20 weeks and 160 mg/dl at 26-30 weeks.
Mello
Giorgio
G
Department of Gynecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy. mellog@unifi.it
Parretti
Elena
E
Cioni
Riccardo
R
Lucchetti
Roberto
R
Carignani
Lucia
L
Martini
Elisabetta
E
Mecacci
Federico
F
Lagazio
Corrado
C
Pratesi
Monica
M
D001786:Blood Glucose / Q000378:metabolism*; D001824:Body Constitution; D015992:Body Mass Index; D003710:Demography; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D007558:Italy; D016013:Likelihood Functions; D008297:Male; D008423:Maternal Age; D008954:Models, Biological; D010298:Parity; D011237:Predictive Value of Tests; D011247:Pregnancy / Q000097:blood*; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D044465:White People
D001786:Blood Glucose