Endocrinol Metab.  2021 Oct;36(5):988-996. 10.3803/EnM.2021.1107.

How Can We Adopt the Glucose Tolerance Test to Facilitate Predicting Pregnancy Outcome in Gestational Diabetes Mellitus?

• Kim KJ
• Kim NH
• Choi J
• Kim SG
• Lee KJ

• KMID: 2521947
• DOI: http://doi.org/10.3803/EnM.2021.1107

Abstract

Background
We investigated how 100-g oral glucose tolerance test (OGTT) results can be used to predict adverse pregnancy outcomes in gestational diabetes mellitus (GDM) patients.
Methods
We analyzed 1,059 pregnant women who completed the 100-g OGTT between 24 and 28 weeks of gestation. We compared the risk of adverse pregnancy outcomes according to OGTT patterns by latent profile analysis (LPA), numbers to meet the OGTT criteria, and area under the curve (AUC) of the OGTT graph. Adverse pregnancy outcomes were defined as a composite of preterm birth, macrosomia, large for gestational age, low APGAR score at 1 minute, and pregnancy-induced hypertension.
Results
Overall, 257 participants were diagnosed with GDM, with a median age of 34 years. An LPA led to three different clusters of OGTT patterns; however, there were no significant associations between the clusters and adverse pregnancy outcomes after adjusting for confounders. Notwithstanding, the risk of adverse pregnancy outcome increased with an increase in number to meet the OGTT criteria (P for trend=0.011); odds ratios in a full adjustment model were 1.27 (95% confidence interval [CI], 0.72 to 2.23), 2.16 (95% CI, 1.21 to 3.85), and 2.32 (95% CI, 0.66 to 8.15) in those meeting the 2, 3, and 4 criteria, respectively. The AUCs of the OGTT curves also distinguished the patients at risk of adverse pregnancy outcomes; the larger the AUC, the higher the risk (P for trend=0.007).
Conclusion
The total number of abnormal values and calculated AUCs for the 100-g OGTT may facilitate tailored management of patients with GDM by predicting adverse pregnancy outcomes.

Keyword

Diabetes; gestational; Pregnancy outcome; Glucose tolerance test

Figure

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  Fig. 1 Pattern of plasma glucose levels according to the latent glucose class (A) and the total number of abnormal values (B) during a 100-g oral glucose tolerance test.

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  Fig. 2 Restricted cubic spine curves of unadjusted odds ratios (ORs) (A) and adjusted ORs (B), and composite adverse pregnancy outcomes (C) according to the area under the curve (AUC) for the oral glucose tolerance test (OGTT). The reference AUC value for ORs was 370.6, which is the mean AUC of the healthy group. The vertical dashed lines represent the first, second, and third quartiles of the AUC, respectively. Model A was adjusted for age, preexisting hypertension, family history of diabetes mellitus, family history of hypertension, pre-pregnancy body mass index, parity (yes or no), and gestational age (before delivery). Model B was adjusted for Model A plus systolic blood pressure at 35 weeks of gestation, diastolic blood pressure at 35 weeks of gestation, fasting blood glucose at 35 weeks of gestation, and insulin treatment. CI, confidence interval.

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