Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes.

OBJECTIVE This article tests the hypothesis that women with impaired glucose tolerance (IGT) have the same pregnancy outcomes as those of their counterparts with normal glucose tolerance. RESEARCH DESIGN AND METHODS From December 1998 to December 1999, 84 of 90 antenatal care base units (ACBUs) under the Tianjin Antenatal Care Network in China participated in the first screening program for gestational diabetes mellitus (GDM). A total of 9,471 pregnant women under the care of participating ACBUs were screened. Of the women screened, 154 were positive for IGT. Of the 154 women, 102 opted for conventional obstetric care. The comparison group was 302 women of normal glucose tolerance (NGT). The initial screening consisted of a 50-g 1-h glucose test, and was carried out at 26-30 gestational weeks. Women with a serum glucose > or =7.8 mmol/l were followed up with a 75-g 2-h oral glucose tolerance test. The World Health Organization's diagnostic criteria for GDM were used. RESULTS Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90-34.93); preterm birth (6.42; 1.46-28.34); breech presentation (3.47; 1.11-10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07-5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors. CONCLUSIONS The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.

[1]  T. R. Hennessy,et al.  Measurement of glucose metabolism and insulin secretion during normal pregnancy and pregnancy complicated by gestational diabetes , 1996, Diabetologia.

[2]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[3]  Xilin Yang,et al.  Gestational diabetes mellitus in women of single gravidity in Tianjin City, China. , 2002, Diabetes care.

[4]  E. Seely,et al.  Brief review: hypertension in pregnancy : a manifestation of the insulin resistance syndrome? , 2001, Hypertension.

[5]  E. Seely,et al.  Hypertension in Pregnancy: A Manifestation of the Insulin Resistance Syndrome? , 2001 .

[6]  F. Lauszus,et al.  Birthweight in women with potential gestational diabetes mellitus ‐ an effect of obesity rather than glucose intolerance? , 1999, Acta obstetricia et gynecologica Scandinavica.

[7]  C. Naylor,et al.  The Toronto Tri-Hospital Gestational Diabetes Project. A preliminary review. , 1998, Diabetes care.

[8]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[9]  P. Ogburn,et al.  Sequelae of unrecognized gestational diabetes. , 1998, American journal of obstetrics and gynecology.

[10]  R. Jarrett.  Should we screen for gestational diabetes? “The concept of gestational diabetes was popularised before considerations of evidence based medicine came on the scene” , 1997, The practising midwife.

[11]  B. Sibai,et al.  The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Calcium for Preeclampsia Prevention (CPEP) Study Group. , 1998, American journal of obstetrics and gynecology.

[12]  K. Leveno,et al.  Pregnancy Outcomes in Women With Gestational Diabetes Compared With the General Obstetric Population , 1997, Obstetrics and gynecology.

[13]  G. Pacini,et al.  Pronounced Insulin Resistance and Inadequate β-cell Secretion Characterize Lean Gestational Diabetes During and After Pregnancy , 1997, Diabetes Care.

[14]  X. Pan,et al.  Prevalence of Diabetes and Its Risk Factors in China, 1994 , 1997, Diabetes Care.

[15]  B. Metzger,et al.  Increased Macrosomia and Perinatal Morbidity Independent of Maternal Obesity and Advanced Age in Korean Women With GDM , 1997, Diabetes Care.

[16]  R. Beard,et al.  Should we screen for gestational diabetes? The case for screening for gestational diabetes , 1997 .

[17]  H. Narchi,et al.  Gestational and pre‐gestational diabetes: comparison of maternal and fetal characteristics and outcome , 1997, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[18]  U. Hanson,et al.  Insulin sensitivity and insulin response in women with gestational diabetes mellitus. , 1997, Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme.

[19]  D. Zhu,et al.  [The effect of gestational impaired glucose tolerance on fetus and newborns]. , 1997, Zhonghua fu chan ke za zhi.

[20]  N. Okun,et al.  A randomized controlled trial of strict glycemic control and tertiary level obstetric care versus routine obstetric care in the management of gestational diabetes: a pilot study. , 1997, American journal of obstetrics and gynecology.

[21]  M. Divon,et al.  Gestational diabetes and preterm labour: is glycaemic control a contributing factor?. , 1997, European journal of obstetrics, gynecology, and reproductive biology.

[22]  L. Marselli,et al.  Screening of gestational diabetes in Tuscany: results in 2000 cases. , 1997, Annali dell'Istituto superiore di sanita.

[23]  E. Rey,et al.  Carbohydrate intolerance in pregnancy: incidence and neonatal outcomes. , 1996, Clinical and investigative medicine. Medecine clinique et experimentale.

[24]  A. Thai,et al.  Gestational diabetes: obstetric and neonatal outcome in 411 cases. , 1996, Singapore medical journal.

[25]  G. Yeo,et al.  Impaired Glucose Tolerance in Pregnancy ‐ Is It of Consequence? , 1996, The Australian & New Zealand journal of obstetrics & gynaecology.

[26]  R. Navalesi,et al.  Neonatal outcome and obstetric complications in women with gestational diabetes: effects of maternal body mass index. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[27]  M. Ardawi,et al.  Determinants of pregnancy outcome in patients with gestational diabetes , 1996, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[28]  C. Naylor,et al.  Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators. , 1996, JAMA.

[29]  X. Wang,et al.  Prospective studies on the relationship between the 50 g glucose challenge test and pregnant outcome. , 1995, Chinese medical journal.

[30]  E. Koukkou,et al.  Difference in prevalence of gestational diabetes and perinatal outcome in an innercity multiethnic London population. , 1995, European journal of obstetrics, gynecology, and reproductive biology.

[31]  B. Metzger,et al.  Effects of Gestational Diabetes on Perinatal Morbidity Reassessed: Report of the International Workshop on Adverse Perinatal Outcomes of Gestational Diabetes Mellitus, December 3–4, 1992 , 1995, Diabetes Care.

[32]  L. Selvaggi,et al.  Does gestational diabetes represent an obstetrical risk factor? , 1994, Gynecologic and obstetric investigation.

[33]  D. Hadden,et al.  Fetal outcome in mothers with impaired glucose tolerance in pregnancy. , 1994, Diabetic medicine : a journal of the British Diabetic Association.

[34]  D. McIntire,et al.  Class A1 Gestational Diabetes: A Meaningful Diagnosis? , 1993, Obstetrics and gynecology.

[35]  K. Teramo,et al.  Hypertension and pre‐eclampsia in women with gestational glucose intolerance , 1993, Acta obstetricia et gynecologica Scandinavica.

[36]  M. Berkus,et al.  Glucose Tolerance Test: Degree of Glucose Abnormality Correlates With Neonatal Outcome , 1993, Obstetrics and gynecology.

[37]  R. Jarrett.  Gestational diabetes: a non-entity? , 1993, BMJ.

[38]  J. Rizvi,et al.  Experience with screening for abnormal glucose tolerance in pregnancy: maternal and perinatal outcome. , 2010, Asia-Oceania journal of obstetrics and gynaecology.

[39]  B. Abrams,et al.  Obstetric Complications With GDM: Effects of Maternal Weight , 1991, Diabetes.

[40]  D. Richards.  Complications of prolonged PROM and oligohydramnios. , 1991, Clinical obstetrics and gynecology.

[41]  M. Bihoreau,et al.  Inheritance of Diabetes Mellitus as Consequence of Gestational Hyperglycemia in Rats , 1990, Diabetes.

[42]  T. Al‐Shawaf,et al.  Does impaired glucose tolerance imply a risk in pregnancy? , 1988, British journal of obstetrics and gynaecology.

[43]  C. Weiner.  Effect of varying degrees of "normal" glucose metabolism on maternal and perinatal outcome. , 1988, American journal of obstetrics and gynecology.

[44]  R. Fraser.  Is treatment needed for mild impairment of glucose tolerance in pregnancy? A randomized controlled trial , 1988, British journal of obstetrics and gynaecology.

[45]  J. Oats,et al.  The Long‐Term Follow‐up of Women with Gestational Diabetes , 1986 .

[46]  J. Oats,et al.  Gestational Diabetes , 1986, The Australian & New Zealand journal of obstetrics & gynaecology.

[47]  K. McFarland,et al.  Neonatal Mortality in Infants of Diabetic Mothers , 1985, Diabetes Care.

[48]  L. Jovanovič,et al.  Screening for Gestational Diabetes: Optimum Timing and Criteria for Retesting , 1985, Diabetes.

[49]  J. Mestman.  Outcome of Diabetes Screening in Pregnancy and Perinatal Morbidity in Infants of Mothers with Mild Impairment in Glucose Tolerance , 1980, Diabetes Care.