title: The relationship between maternal glycemia and perinatal outcome.
abstract: OBJECTIVE
  To examine the relationship between varying degrees of maternal hyperglycemia and pregnancy outcomes.
  
  
  METHODS
  This was a secondary analysis of a treatment trial for mild gestational diabetes including four cohorts: 1) 473 women with untreated mild gestational diabetes; 2) 256 women with a positive 50-g screen and one abnormal oral glucose tolerance test (OGTT) value; 3) 675 women with a positive screen and no abnormal OGTT values; and 4) 437 women with a normal 50-g screen. Groups were compared by test of trend for a composite perinatal outcome (neonatal hypoglycemia, hyperbilirubinemia, elevated cord C-peptide level, and perinatal trauma or death), frequency of large for gestational age neonates, shoulder dystocia, and pregnancy-related hypertension. Three-hour OGTT levels (fasting, 1-, 2-, and 3-hour) levels were divided into categories and analyzed for their relationship to perinatal and maternal outcomes.
  
  
  RESULTS
  There were significant trends by glycemic status among the four cohorts for the composite and all other outcomes (P<.001). Analysis for trend according to OGTT categories showed an increasing relationship between fasting and all postload levels and the various outcomes (P<.05). Fasting glucose 90 mg/dL or greater and 1 hour 165 mg/dL or greater were associated with an increased risk for the composite outcome (odds ratios and 95% confidence intervals of 2.0 [1.03–4.15] and 1.46 [1.02–2.11] to 1.52 [1.08–2.15] for the fasting and 1 hour, respectively). A 1 hour glucose 150 mg/dL or greater was associated with an increased risk for large for gestational age (odds ratios, 1.8 [1.02–3.18] to 2.35 [1.35–4.14]); however, 2- and 3-hour glucose levels did not increase the risk for the composite or large for gestational age until well beyond current gestational diabetes diagnostic thresholds.
  
  
  CONCLUSIONS
  A monotonic relationship exists between increasing maternal glycemia and perinatal morbidity. Current OGTT criteria require reevaluation in determining thresholds for the diagnosis and treatment of gestational diabetes.
  
  
  METHODS
  II
authors.affiliation: From the Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio; The George Washington University Biostatistics Center, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the Departments of Obstetrics and Gynecology at Brown University, Providence, Rhode Island; The University of Texas Health Science Center at Houston, Houston, Texas; The University of Texas Southwestern Medical Center, Dallas, Texas; Columbia University, New York, New York; University of Utah, Salt Lake City, Utah; University of Alabama at Birmingham, Birmingham, Alabama; University of North Carolina, Chapel Hill, North Carolina; Drexel University, Philadelphia, Pennsylvania; Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio; Wake Forest University Health Sciences, Winston-Salem, North Carolina; University of Texas Medical Branch, Galveston, Texas; University of Pittsburgh, Pittsburgh, Pennsylvania; Wayne State University, Detroit, Michigan; Northwestern University, Chicago, Illinois; and Oregon Health and Science University, Portland, Oregon.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Landon
authors.forename: Lisa
authors.initials: L
authors.lastname: Mele
authors.forename: Catherine Y
authors.initials: CY
authors.lastname: Spong
authors.forename: Marshall W
authors.initials: MW
authors.lastname: Carpenter
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ramin
authors.forename: Brian
authors.initials: B
authors.lastname: Casey
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Wapner
authors.forename: Michael W
authors.initials: MW
authors.lastname: Varner
authors.forename: Dwight J
authors.initials: DJ
authors.lastname: Rouse
authors.forename: John M
authors.initials: JM
authors.lastname: Thorp
authors.forename: Anthony
authors.initials: A
authors.lastname: Sciscione
authors.forename: Patrick
authors.initials: P
authors.lastname: Catalano
authors.forename: Margaret
authors.initials: M
authors.lastname: Harper
authors.forename: George
authors.initials: G
authors.lastname: Saade
authors.forename: Steve N
authors.initials: SN
authors.lastname: Caritis
authors.forename: Yoram
authors.initials: Y
authors.lastname: Sorokin
authors.forename: Alan M
authors.initials: AM
authors.lastname: Peaceman
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Tolosa
authors.forename: Garland D
authors.initials: GD
authors.lastname: Anderson
mesh_terms: D000328:Adult; D001786:Blood Glucose; D016640:Diabetes, Gestational / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001786:Blood Glucose