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The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy
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Citations from the Literature
Fifteen patients with nonmetastatic gestational trophoblastic disease were treated solely with methotrexate given orally rather than intramuscularly. Remission, defined as a betahuman choronic gonadotropin titer of < 5 mIU/ml for 3 consecutive weeks, was attained in 13 (87%) of the 15 patients. Level of toxicity was acceptable. Patient comfort, convenience, and less time off work and in the physician’s office are significant advantages to this efficacious, well-tolerated method of therapy. Early ttdrd-trimester ultrasound screening in gestational diibetes to determine the risk of macrosomia and labor dystocia at term Bochner CJ; Medearis AL; Williams J III; et al Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA AM. J. OBSTET. GYNECOL.; 157/3 (703-708)/1987/ The purpose of this study was to determine whether an early third-trimester fetal abdominal circumference measurement can be used in patients with gestational diabetes to predict the presence or absence of macrosomia and labor dystocia at term. The predictive accuracy of a 30- to 33-week abdominal circumference measurement was tested, using the ninetieth percentile as the discriminant point. The study consisted of 201 patients with gestational diabetes who maintained weekly fasting glucose levels < 100 mg/dl and 2-hour postprandial glucose levels < 120 mg/dl with dietary management alone. The predictive accuracy of a 30- to 33-week fetal abdominal circumference measurement was %.4% for ruling out macrosomia and 56.3% for predicting macrosomia. Patients with fetal abdominal circumference measurements > the ninetieth percentile at 30 to 33 weeks had a significantly increased incidence of cesarean section for failure to progress, shoulder dystocia, and birth trauma, whereas patients with abdominal circumference measurements ( the ninetieth percentile were at no greater risk than the general population. These results suggest that patients with non-insulin-dependent gestational diabetes with fetal abdominal circumference measurements < the ninetieth percentile at 30 to 33 weeks are not at increased risk for macrosomia, cesarean section, or birth trauma at term, as long as their weekly glucose testing remains within normal limits. Efforts to decrease the incidence of macrosomia and its attendant risks should focus on those gesational diabetic patients whose fetal abdominal circumference > the ninetieth percentile at 30 to 33 weeks. Tbe signtftcance of one abnormal glucose tolerance test value on adverse outcome in pregnancy Langer 0; Brustman L; Anyaegbunam A; Mazze R Department of Obstetrics and Gynecology, The Diabetes Research and Training Center, The Albert Einstein College of Medicine, Bronx, NY 10461, USA AM. J. OBSTET. GYNECOL.; 15713 (758-763)/1987/ A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test Int JGynecol Obstet 27
results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p < 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p < 0.01) and gestational diabetes mellitus group (34% versus 12%; p < 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3Vo). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome. Gestational diabetes: Maternal response to diet and insulin therapy as reflected by glycosylated hemoglobin concentration Granclis As; Morris MA; Litton JC Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC27714 USA AM. J. OBSTET. GYNECOL.; 15715 (1118-1121)/1987/ To assess the effects of diet and insulin therapy on pregnancy complicated by gestational diabetes, glycosylated hemoglobin concentration was determined longitudinally in 32 women. Diet was instituted when a diagnosis of gestational diabetes was made and was supplemented with insulin for fasting hyperglycemia. At initial presentation, glycosylated hemoglobin concentration was increased in the 18 women who required insulin compared with the 14 women managed by diet alone (7.1% t 0.2% versus 6.2% f 0.2070,mean f SEM, p < 0.01). Diet had no effect on glycosylated hemoglobin concentration that remained elevated to 6.1% f 0.3 % compared with the glycosylated hemoglobin concentration of 5.6% f 0.2% for pregnant nondiabetic women (p < 0.01). Insulin resulted in a decrease in glycosylated hemoglobin concentration within 3 to 5 weeks (p < 0.05). After 7 to 9 weeks of insulin and diet, the glycosylated hemoglobin concentration in women with fasting hyperglycemia was the same as the glycosylated hemoglobin concentration in women who were managed by diet alone. Emotional responses of pregnant women to cborionic villi sampling or amniocentesis Spencer JW; Cox DN Department of Psychologv. Simon Fraser University, Burnaby, BC VSA lS6, Canada AM. J. OBSTET. GYNECOL.; 15715 (1155-1160)/1987/ Seventy-four ‘high-risk’ pregnant women interested in participating in a clinical trial comparing chorionic villi
Citations from the Literature
Fifteen patients with nonmetastatic gestational trophoblastic disease were treated solely with methotrexate given orally rather than intramuscularly. Remission, defined as a betahuman choronic gonadotropin titer of < 5 mIU/ml for 3 consecutive weeks, was attained in 13 (87%) of the 15 patients. Level of toxicity was acceptable. Patient comfort, convenience, and less time off work and in the physician’s office are significant advantages to this efficacious, well-tolerated method of therapy. Early ttdrd-trimester ultrasound screening in gestational diibetes to determine the risk of macrosomia and labor dystocia at term Bochner CJ; Medearis AL; Williams J III; et al Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA AM. J. OBSTET. GYNECOL.; 157/3 (703-708)/1987/ The purpose of this study was to determine whether an early third-trimester fetal abdominal circumference measurement can be used in patients with gestational diabetes to predict the presence or absence of macrosomia and labor dystocia at term. The predictive accuracy of a 30- to 33-week abdominal circumference measurement was tested, using the ninetieth percentile as the discriminant point. The study consisted of 201 patients with gestational diabetes who maintained weekly fasting glucose levels < 100 mg/dl and 2-hour postprandial glucose levels < 120 mg/dl with dietary management alone. The predictive accuracy of a 30- to 33-week fetal abdominal circumference measurement was %.4% for ruling out macrosomia and 56.3% for predicting macrosomia. Patients with fetal abdominal circumference measurements > the ninetieth percentile at 30 to 33 weeks had a significantly increased incidence of cesarean section for failure to progress, shoulder dystocia, and birth trauma, whereas patients with abdominal circumference measurements ( the ninetieth percentile were at no greater risk than the general population. These results suggest that patients with non-insulin-dependent gestational diabetes with fetal abdominal circumference measurements < the ninetieth percentile at 30 to 33 weeks are not at increased risk for macrosomia, cesarean section, or birth trauma at term, as long as their weekly glucose testing remains within normal limits. Efforts to decrease the incidence of macrosomia and its attendant risks should focus on those gesational diabetic patients whose fetal abdominal circumference > the ninetieth percentile at 30 to 33 weeks. Tbe signtftcance of one abnormal glucose tolerance test value on adverse outcome in pregnancy Langer 0; Brustman L; Anyaegbunam A; Mazze R Department of Obstetrics and Gynecology, The Diabetes Research and Training Center, The Albert Einstein College of Medicine, Bronx, NY 10461, USA AM. J. OBSTET. GYNECOL.; 15713 (758-763)/1987/ A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test Int JGynecol Obstet 27
results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p < 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p < 0.01) and gestational diabetes mellitus group (34% versus 12%; p < 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3Vo). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome. Gestational diabetes: Maternal response to diet and insulin therapy as reflected by glycosylated hemoglobin concentration Granclis As; Morris MA; Litton JC Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC27714 USA AM. J. OBSTET. GYNECOL.; 15715 (1118-1121)/1987/ To assess the effects of diet and insulin therapy on pregnancy complicated by gestational diabetes, glycosylated hemoglobin concentration was determined longitudinally in 32 women. Diet was instituted when a diagnosis of gestational diabetes was made and was supplemented with insulin for fasting hyperglycemia. At initial presentation, glycosylated hemoglobin concentration was increased in the 18 women who required insulin compared with the 14 women managed by diet alone (7.1% t 0.2% versus 6.2% f 0.2070,mean f SEM, p < 0.01). Diet had no effect on glycosylated hemoglobin concentration that remained elevated to 6.1% f 0.3 % compared with the glycosylated hemoglobin concentration of 5.6% f 0.2% for pregnant nondiabetic women (p < 0.01). Insulin resulted in a decrease in glycosylated hemoglobin concentration within 3 to 5 weeks (p < 0.05). After 7 to 9 weeks of insulin and diet, the glycosylated hemoglobin concentration in women with fasting hyperglycemia was the same as the glycosylated hemoglobin concentration in women who were managed by diet alone. Emotional responses of pregnant women to cborionic villi sampling or amniocentesis Spencer JW; Cox DN Department of Psychologv. Simon Fraser University, Burnaby, BC VSA lS6, Canada AM. J. OBSTET. GYNECOL.; 15715 (1155-1160)/1987/ Seventy-four ‘high-risk’ pregnant women interested in participating in a clinical trial comparing chorionic villi