Pancreatic beta-cell function and fetal growth in gestational impaired glucose tolerance.
OBJECTIVE
To investigate the metabolic phenotype and pregnancy outcomes of gestational impaired glucose tolerance (IGT) defined by isolated hyperglycemia during an oral glucose tolerance test (OGTT).


METHODS
Retrospective cohort study.


METHODS
University referral hospital.


METHODS
A total of 4,789 women were screened for gestational diabetes mellitus (GDM) between 1996 and 2008 with a glucose challenge test (GCT), followed by a 2-hour 75-g OGTT if the GCT result was abnormal; in addition, measurement of plasma insulin concentration during the OGTT was implemented from 2004.


METHODS
The insulin sensitivity (IS(OGTT)) and beta-cell function (insulinogenic index/homeostasis model assessment for insulin resistance) were calculated for 283 women who underwent a diagnostic OGTT between 2004 and 2008. Perinatal complications were examined in 4,789 women who were screened for GDM between 1996 and 2008.


METHODS
Comparison of outcomes among women stratified by glucose tolerance status using the GCT and OGTT profiles.


RESULTS
Insulin sensitivity and beta-cell function significantly decreased from normal OGTT to 2-hour IGT (single hyperglycemia at 2 hours) to 1-hour IGT (single hyperglycemia at 1 hour) to GDM, with significant differences between normal OGTT and 1-hour IGT or GDM. The occurrence of large-for-gestational age (LGA) neonates was significantly increased in women with GDM or 1-hour IGT (adjusted odds ratio: 2.15, 2.22; 95% confidence interval 1.23-3.75 and 1.04-4.35, respectively) compared to those with normal GCT or normal diagnostic OGTT results.


CONCLUSIONS
Like GDM, isolated 1-hour hyperglycemia on the OGTT is associated with beta-cell dysfunction and an increased risk for LGA neonates.
Miyakoshi
Kei
K
Department of Obstetrics and Gynecology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. kei@sc.itc.keio.ac.jp
Tanaka
Mamoru
M
Saisho
Yoshifumi
Y
Shimada
Akira
A
Minegishi
Kazuhiro
K
Kim
Seon Hye
SH
Asai
Satoshi
S
Itoh
Hiroshi
H
Yoshimura
Yasunori
Y
D000328:Adult; D044466:Asian People; D001786:Blood Glucose / Q000032:analysis; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis / Q000378:metabolism*; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D005320:Fetal Macrosomia / Q000378:metabolism; D018149:Glucose Intolerance / Q000097:blood / Q000175:diagnosis / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000378:metabolism*; D007231:Infant, Newborn; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000175:diagnosis / Q000378:metabolism; D011256:Pregnancy Outcome; D012189:Retrospective Studies
D001786:Blood Glucose