An Abnormal 1 Hour Glucose Screen and Ultrasound Evidence of Hyperglycemia Should Be Managed as Gestational Diabetes [6C]. (May 2017) - Crimmins, Sarah
Abstract : INTRODUCTION: To investigate the risk of impaired glucose metabolism (IGM) and ultrasound findings consistent with hyperglycemia on maternal and neonatal outcomes. METHODS: Retrospective case-control study of singleton, non-anomalous fetuses with IGM and gestational diabetes (GDM). IGM was defined as a one hour GST of greater than 134 but less than 2 abnormal values on 3 hour GTT. Ultrasound evidence of hyperglycemia was defined as abdominal circumference greater than 95th percentile and/or polyhydramnios. Individuals with IGM were divided into those with ultrasound evidence of hyperglycemia (IGM-US) and those without (IGM). Maternal demographics, delivery (gestational age (GA) at delivery, delivery mode, shoulder dystocia, lacerations), postpartum hemorrhage (PPH), and neonatal outcome (birth weight percentile (BW%), NICU admission, hypoglycemia, respiratory complications, glucose, and length of stay) were recorded. Composite morbidity was tabulated. Delivery and neonatal outcome variables were compared in individuals with IGM-US, IGM, and GDM. Odds ratios were calculated and adjusted with maternal age, race and gestational age at delivery. RESULTS: A total of 324 individuals with an abnormal 1-hour were included (96 with IGM-US, 108 with IGM, and 120 with GDM). In comparison to the IGM group, IGM-US had higher rates of induction, cesarean delivery, BW% > 90th percentile at delivery, and respiratory complications in the neonate (p less than 0.05 for all). Individuals with IGM-US had significantly larger neonates by birth weight and percentile than individuals with GDM (67.04[3.9-99.9 v 59.9[1.7-99.9](p = 0.001). The remaining outcomes were similar. CONCLUSION: Women with IGM and ultrasound markers of hyperglycemia should be identified and managed as a gestational diabetic.