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Tuesday, May 14, 2013

Trailers (49): Glucose challenge test results and perinatal outcomes

Figueroa et al. Relationship between 1-hour glucose challenge test results and perinatal outcomes

Why should you read about this topic?

Abnormal glucose tolerance during pregnancy is predictive of maternal and perinatal adverse outcomes.  The glucose challenge test (GCT) results may be useful for estimating risks for those outcomes.

What were the authors trying to do?

Define the association between the 1-hour 50 g GCT values and perinatal outcomes.

Who participated and in what setting?

Pregnant women with a GCT <120 mg/dL (N=436) and untreated pregnant women with a GCT 135-199 mg/dL (N=1403) and a fasting <95 mg/dL in the MFMU trial of treatment of mild gestational diabetes (GDM)

What was the study design?

Secondary analysis of the MFMU trial

What were the main outcome measures?

Composite perinatal (stillbirth, neonatal death, hypoglycemia, hyperbilirubinemia, neonatal hyperinsulinemia, and birth trauma), LGA, and macrosomia

What were the results?

Compared with GCT <120, women with a GCT 140-199 had higher rates of the composite outcome, LGA, and macrosomia.  Women with a GCT 135-139 did not have higher rates of any of these three outcomes.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: large number of untreated participants studied prospectively. Weaknesses: women with GCT values between 121-134 were not studied; composite outcome; long-term outcomes not studied.

What does the study contribute for your practice?

When using the two-step approach to diagnose GDM, a GCT threshold of 140 may be the most reasonable choice.