Maternal and fetal outcomes if gestational impaired glucose tolerance is not treated.
OBJECTIVE
To evaluate whether there is increased maternal or neonatal morbidity in connection with impaired glucose tolerance (IGT) during pregnancy when the condition is not treated.


METHODS
During the study period of 1997-2001, in a defined geographical area in Sweden, the diagnostic criteria for gestational diabetes mellitus (GDM) were limited to the criteria for diabetes. Prospectively, 213 women who were identified with IGT during pregnancy were undiagnosed and untreated. Data on maternal and fetal outcome was collected from records. For each case subject, four control subjects were taken from the same delivery department.


RESULTS
The proportion of women who underwent cesarean section was significantly higher in the case subjects than in the control subjects and was independently associated with IGT. The adjusted odds ratio (OR) was 1.9 (95% CI 1.2-2.9). The proportion of infants who were large for gestational age (LGA), defined as birth weight >2 SDs greater than the mean for gestation and sex, was independently significantly associated with untreated IGT during pregnancy (OR 7.3, 95% CI 4.1-12.7). Admission to a neonatal intensive care unit (NICU) for 2 days or longer was more common (adjusted OR 2.0, 95% CI 1.1-3.8). However, 71.3% of the children in the IGT group and 87.3% of the control subjects had no neonatal complications.


CONCLUSIONS
There is increased independent association between cesarean section rate, prematurity, LGA, and macrosomic infants born to mothers with untreated IGT. Most of the children were healthy, but there is still increased morbidity. Therefore, to evaluate the effects of treatment, there is a need for a randomized study.
Ostlund
Ingrid
I
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. ingrid.ostlund@oreboll.se
Hanson
Ulf
U
Björklund
Anders
A
Hjertberg
Ragnhild
R
Eva
Nord
N
Nordlander
Elisabeth
E
Swahn
Marja-Liisa
ML
Wager
Jan
J
D000328:Adult; D001724:Birth Weight; D001835:Body Weight; D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000150:complications*; D005260:Female; D018149:Glucose Intolerance / Q000175:diagnosis*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D016017:Odds Ratio; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011256:Pregnancy Outcome; D012016:Reference Values; D013548:Sweden