Prediction of low birth weight with hypoglycemia in glucose tolerance test
DOI:
https://doi.org/10.11606/s1518-8787.2021055002543Keywords:
Hypoglycemia, Glucose tolerance test, Infant, low birth weight, Longitudinal studiesAbstract
OBJECTIVE: Determine the value of the combination of fasting glucose less than the 10th percentile (FG < p10) during 75 gram oral glucose tolerance test (75g OGTT) with maternal characteristics to predict low birth weight (LBW) established by Intergrowth-21st tables. METHODS: Prospective cohort study of pregnant women who was underwent 75g OGTT between 24 and 28.6 weeks. The 10th percentile fasting glucose of the population was determined at 65 mg/dL and women with risk factors that could modify fetal weight, including those related to intrauterine growth restriction, were excluded. Two groups were formed: group FG < p10 and group with normal fasting glucose. The main finding was the diagnosis of LBW. The association between FG < p10, maternal characteristics and LBW was established by multivariate logistic regression. The predictive performance of the models constructed was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis. RESULTS: 349 women were eligible for study, of whom 66 (18.91%) had FG < p10; neonates in this group had lower birth weights (2947.28 g and 3138.26 g, p = 0.001), higher frequencies of LBW (25% and 6.81%, p < 0.001) and of weights < 2500 g in term births (8.6% and 2.3%, p = 0.034). The basal prediction model consisted of nulliparity by achieving an AUC of 60%, while the addition of FG < p10 resulted in the significant improvement of the previous model (AUC 72%, DeLong: p = 0.005). CONCLUSIONS: In pregnant women without factors that could modify fetal weight, the predictive model created by combining FG < p10 during 75g OGTT with nulliparity was significantly associated with increased risk of LBW.
References
. Blencowe H, Krasevec J, Onis M, Black RE, An X, Stevens GA, et al. National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. Lancet Glob Health 2019;7:849-60. https://doi.org/10.1016/S2214-109X(18)30565-5 [ Links ]
Katz J, Lee AC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013 Aug 3;382: 417-25. https://doi.org/10.1016/S0140-6736(13)60993-9 [ Links ]
Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M. Glycemic control in gestational diabetes mellitus--how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol. 1989;161(3):646-53. https://doi.org/10.1016/0002-9378(89)90371-2 [ Links ]
Abell DA, Beischer NA. Evaluation of the three-hour oral glucose tolerance test in detection of significant hyperglycemia and hypoglycemia in pregnancy. Diabetes. 1975;24(10):874-80. https://doi.org/10.2337/diab.24.10.874 [ Links ]
Melamed N, Hiersch L, Peled Y, Hod M, Wiznitzer A, Yogev Y. The association between low 50 g glucose challenge test result and fetal growth restriction. J Matern Fetal Neonatal Med. 2013 Jul;26(11):1107-11. https://doi.org/10.3109/14767058.2013.770460 [ Links ]
Bayraktar B, Balıkoğlu M, Kanmaz AG. Pregnancy outcomes of women with hypoglycemia in the oral glucose tolerance test. J Gynecol Obstet Hum Reprod. 2020 Apr;49(4):101703. https://doi.org/10.1016/j.jogoh.2020.1017 [ Links ]
Caruso A, Paradisi G, Ferrazzani S, Lucchese A, Moretti S, Fulghesu AM. Effect of maternal carbohydrate metabolism on fetal growth. Obstet Gynecol. 1998;92(1):8-12. https://doi.org/10.1016/s0029-7844(98)00138-0 [ Links ]
Markestad T, Bergsjø P, Aakvaag A, Lie RT, Jacobsen G, Hoffman HJ et al. Prediction of fetal growth based on maternal serum concentrations of human chorionic gonadotropin, human placental lactogen and estriol. Acta Obstet Gynecol Scand Suppl.1997;165:50-5. [ Links ]
Holme AM, Roland MC, Lorentzen B, Michelsen TM, Henriksen T. Placental glucose transfer: a human in vivo study. PLoS One. 2015 Feb 13;10(2):e0117084. https://doi.org/10.1371/journal.pone.0117084 [ Links ]
Langer O, Damus K, Maiman M, Divon M, Levy J, Bauman W. A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation. Am J Obstet Gynecol.1986 Oct;155(4):711-6. https://doi.org/10.1016/s0002-9378(86)80004-7 [ Links ]
Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care 2020 Jan;43(Suppl.1):14-31. https://doi.org/10.2337/dc20-S002 [ Links ]
ter Braak EWMT, Evers IM, Erkelens DW, Visser GHA. Maternal hypoglycemia during pregnancy in type 1 diabetes: maternal and fetal consequences. Diabetes Metab Res Rev. 2002;18(2):96-105. https://doi.org/10.1002/dmrr.271 [ Links ]
HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002. https://doi.org/10.1056/NEJMoa0707943 [ Links ]
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005 Jun 16;352(24):2477-86. https://doi.org/10.1056/NEJMoa042973 [ Links ]
Papageorghiou AT, Ohuma EO, Altman DG, Todros T, Cheikh-Ismail L, Lambert A, et al. International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. Lancet. 2014 Sep 6;384(9946):869-79. https://doi.org/10.1016/S0140-6736(14)61490-2 [ Links ]
Delibas IB, Tanriverdi S, Cakmak B. Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes? Ginekol Pol. 2018;89(1):25-9. https://doi.org/10.5603/GP.a2018.0005 [ Links ]
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics, Society for Maternal-Fetal Medicin. Practice Bulletin No. 204: Fetal Growth Restriction. Obstet Gynecol. 2019 Feb;133(2):97-109. https://doi.org/10.1097/AOG.0000000000003070 [ Links ]
Rhee J, Kim R, Kim Y, Tam M, Lai Y, Keum N, et al. Maternal Caffeine Consumption during Pregnancy and Risk of Low Birth Weight: A Dose-Response Meta-Analysis of Observational Studies. PLoS ONE. 2015 Jul 20;10(7):e0132334. https://doi.org/10.1371/journal.pone.0132334 [ Links ]
Sonek JD, Kagan KO, Nicolaides KH. Inverted Pyramid of Care. Clin Lab Med. 2016 Jun;36(2):305-17. https://doi.org/10.1016/j.cll.2016.01.009 [ Links ]
American College of Obstetricians and Gynecologists. Committee Opinion No. 548. ACOG Committee opinion no. 548: weight gain during pregnancy. Obstet Gynecol. 2013 Jan;121(1):210-2. https://doi.org/10.1097/01.aog.0000425668.87506.4c [ Links ]
Institute of Medicine, National Research Council Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington D.C.: National Academies Press, 2009. [ Links ]
Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Mata FAF, Lyrio AO, et al. Maternal Anemia and Low Birth Weight: A Systematic Review and Meta-Analysis. Nutrients. 2018 May 12;10(5):601. https://doi.org/10.3390/nu10050601 [ Links ]
Figueras F, Gratacós E. Update on the diagnosis and classification of fetal growth restriction and proposal of a stage-based management protocol. Fetal Diagn Ther. 2014;36(2):86-98. https://doi.org/10.1159/000357592 [ Links ]
Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational-age fetus: Green-top guideline No. 31. 2013. 2nd rev. ed. London: Royal College of Obstetricians and Gynaecologists, 2014. 34 p. [ Links ]
Economides DL, Nicolaides KH. Blood glucose and oxygen tension levels in small-for-gestational-age fetuses. Am J Obstet Gynecol.1989 Feb 1;160(2):385-9. https://doi.org/10.1016/0002-9378(89)90453-5 [ Links ]
Illsley NP, Baumann MU. Human placental glucose transport in fetoplacental growth and metabolism. Biochim Biophys Acta Mol Basis Dis. 2020 Feb 1;1866(2):165359. https://doi:10.1016/j.bbadis.2018.12.010 [ Links ]
Kwon H, Lee J, Lee BW, Kwon JY, Kim YH. The association between low 50 g glucosa challenge test values and adverse pregnancy outcomes. J Womens Health (Larchmt). 2018;27(6):801-7.https://doi.org/10.1089/jwh.2017.6579 [ Links ]
Naik D, Shyamasunder AH, Mruthyunjaya MD, Patil RG, Paul TV, Christina F, et al. Masked hypoglycemia in pregnancy. J Diabetes. 2017 Aug;9(8):778-86. https://doi.org/10.1111/1753-0407.12485 [ Links ]
Calfee EF, Rust OA, Bofill JA, Ross EL, Morrison JC. Maternal hypoglycemia: is it associated with adverse perinatal outcome? J Perinatol. 1999;19(5):379-82. https://doi.org/10.1038/sj.jp.7200048 [ Links ]
Pugh SK, Doherty DA, Magann EF, Chauhan SP, Hill JB, Morrison JC. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy?. Reprod Health. 2009 Jul 14;6:10. https://doi.org/10.1186/1742-4755-6-10 [ Links ]
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