title: Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis.
abstract: OBJECTIVE
  The purpose of this study was to determine whether women with 1 abnormal value on 3-hour 100-g oral glucose tolerance test are at an increased risk for adverse pregnancy outcomes.
  
  
  METHODS
  Gestational diabetes mellitus is diagnosed by a 2-step method, with a 3-hour, 100-g oral glucose tolerance test that is reserved for women with an abnormal 1-hour, 50-g glucose challenge test. Although the increased maternal-fetal morbidity with gestational diabetes mellitus is well established, controversy remains about the risk that is associated with an isolated abnormal value during a 3-hour, 100-g oral glucose tolerance test.
  
  
  METHODS
  Prospective and retrospective studies that evaluated the maternal and perinatal impact of 1 abnormal glucose value during a 3-hour, 100-g oral glucose tolerance test were identified with the use of computerized databases. Data were extracted and quantitative analyses were performed.
  
  
  RESULTS
  Twenty-five studies (7 prospective and 18 retrospective) that met criteria for metaanalysis included 4466 women with 1 abnormal glucose value on oral glucose tolerance test. Patients with 1 abnormal glucose value had significantly worse pregnancy outcomes compared with women with zero abnormal values with the following pooled odds ratios: macrosomia, 1.59 (95% confidence interval, 1.16-2.19); large for gestational age, 1.38 (95% confidence interval, 1.09-1.76); increased mean birthweight, 44.5 g (95% confidence interval, 8.10-80.80 g); neonatal hypoglycemia, 1.88 (95% confidence interval, 1.05-3.38); total cesarean delivery, 1.69 (95% confidence interval, 1.40-2.05); pregnancy-induced hypertension, 1.55 (95% confidence interval, 1.31-1.83), and Apgar score of <7 at 5 minutes, 6.10 (95% confidence interval, 2.65-14.02). There was also an increase in neonatal intensive care unit admission and respiratory distress syndrome. Similar results were seen that compared 1 abnormal glucose value to a population with a normal 1-hour 50-g glucose challenge test (normal glucose screen). With the exception of birthweight, outcomes of patients with 1 abnormal glucose value were similar to outcomes of patients with gestational diabetes mellitus.
  
  
  CONCLUSIONS
  Women with 1 abnormal value on 3-hour, 100-g oral glucose tolerance test have a significantly increased risk for poor outcomes comparable with women who have gestational diabetes mellitus.
authors.affiliation: University of Florida College of Medicine-Jacksonville, Department of Obstetrics and Gynecology, Jacksonville, FL. Electronic address: jared.roeckner@jax.ufl.edu.
authors.forename: Jared T
authors.initials: JT
authors.lastname: Roeckner
authors.affiliation: Division of Maternal Fetal Medicine, Jacksonville, FL.
authors.forename: Luis
authors.initials: L
authors.lastname: Sanchez-Ramos
authors.affiliation: University of Florida College of Medicine-Jacksonville, Department of Obstetrics and Gynecology, Jacksonville, FL.
authors.forename: Rubymel
authors.initials: R
authors.lastname: Jijon-Knupp
authors.affiliation: University of Florida College of Medicine-Jacksonville, Department of Obstetrics and Gynecology, Jacksonville, FL.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kaunitz
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis*; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D001786:Blood Glucose
keywords: 1 abnormal value; birthweight; gestational diabetes mellitus; glucose tolerance; large for gestational age; macrosomia; neonatal hypoglycemia; oral glucose tolerance test