Background: International Association for Diabetes in Pregnancy Study Group (IADPSG) criteria recommends single step OGTT for diagnosis of gestational diabetes mellitus (GDM). The main concerns with IADPSG criteria are i) only one abnormal value is required and ii) fasting plasma glucose (FPG) cut point is too low. We report on association between number of abnormal glucose values and levels of FPG with pregnancy outcomes.
Methods: Pregnant women (n=1,044) were screened for GDM using IADPSG criteria. OGTT’s were classified based on the number of abnormal glucose values (any one value vs. more than one value), and FPG values (<92mg/dl,92-100mg/dl,>100mg/dl) and correlated with pregnancy outcomes. Odds Ratios were adjusted for age, BMI, family history of diabetes, history of GDM, birth weight, gestational week at diagnosis and delivery. For macrosomia, birth weight was not included.
Results: For caesarean sections, risk was higher in women with any one abnormal glucose value (OR:1.53;95%CI:1.08-2.16) and it increased further in those with more than one abnormal value (OR:1.58;95%CI:0.99-2.52), compared to women with normal glucose tolerance (NGT). Risk of caesarean section was also higher in women with FPG (92-100mg/dl) (OR:1.36;95%CI:0.86-2.15) and even higher in women with FPG >100mg/dl (OR:1.88;95%CI:1.08-3.29) when compared to FPG <92mg/dl. For macrosomia, women with any one abnormal value (OR:1.49;95%CI:0.96-2.33) and with more than one abnormal value (OR:1.07;95%CI:0.57-2.03) had higher risk compared to women with NGT. Risk of macrosomia was also higher in women who had FPG 92-100mg/dl (OR:1.04;95%CI:0.56-1.95) and FPG >100mg/dl (OR:1.61;95%CI:0.83-3.10) compared to FPG<92mg/dl.
Conclusion: The risk for poor pregnancy outcomes starts in those with one abnormal value in the OGTT or with FPG >92mg/dl and the risk further increases with higher abnormal values.
B. Balaji: None. R. Anjana: None. M. Deepa: None. P. Rajendra: None. U. Ram: None. P. Saravanan: None. V. Mohan: None.