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.
OBJECTIVE DATA 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. STUDY 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. STUDY APPRAISAL AND SYNTHESIS 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. CONCLUSION 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.
American journal of obstetrics and gynecology