Hyperglycemia and adverse pregnancy outcomes

Boyd E. Metzger; M. Contreras; D. A. Sacks; W. Watson; S. L. Dooley; M. Foderaro; C. Niznik; J. Bjaloncik; P. M. Catalano; L. Dierker; S. Fox; L. Gullion; C. Johnson; C. A. Lindsay; H. Makovos; F. Saker; M. W. Carpenter; J. Hunt; M. H. Somers; K. S. Amankwah; P. C. Chan; B. Gherson; E. Herer; B. Kapur; A. Kenshole; G. Lawrence; K. Matheson; L. Mayes; K. McLean; H. Owen; C. Cave; G. Fenty; E. Gibson; A. Hennis; G. McIntyre; Y. E. Rotchell; C. Spooner; H. A.R. Thomas; J. Gluck; D. R. Hadden; H. Halliday; J. Irwin; O. Kearney; J. McAnee; D. R. McCance; M. Mousavi; A. I. Traub; J. K. Cruickshank; N. Derbyshire; J. Dry; A. C. Holt; F. Khan; C. Lambert; M. Maresh; F. Prichard; C. Townson; T. W. Van Haeften; A. M.R. Van De Hengel; G. H.A. Visser; A. Zwart; U. Chaovarindr; U. Chotigeat; C. Deerochanawong; I. Panyasiri; P. Sanguanpong; D. Amichay; A. Golan; K. Marks; M. Mazor; J. Ronen; A. Wiznitzer; R. Chen; D. Harel; N. Hoter; N. Melamed; J. Pardo; M. Witshner; Y. Yogev; F. Bowling; D. Cowley; P. Devenish-Meares; H. G. Liley; A. McArdle; H. D. McIntyre; B. Morrison; A. Peacock; A. Tremellen; D. Tudehope; K. Y. Chan; N. Y. Chan; L. W. Ip; S. L. Kong; Y. L. Lee; C. Y. Li; K. F. Ng; P. C. Ng; M. S. Rogers; K. W. Wong; M. Edgar; W. Giles; A. Gill; R. Glover; J. Lowe; F. Mackenzie; K. Siech; J. Verma; A. Wright; Y. H. Cao; J. J. Chee; A. Koh; E. Tan; V. J. Rajadurai; H. Y. Wee; G. S.H. Yeo; D. Coustan; B. Haydon; A. Alexander; D. R. Hadden; O. Attias-Raved; M. Hod; J. J.N. Oats; A. F. Parry; A. Collard; A. S. Frank; L. P. Lowe; A. Thomas; T. Case; P. Cholod; A. R. Dyer; L. Engelman; M. Xiao; L. Yang; C. I. Burgess; T. R.J. Lappin; G. S. Nesbitt; B. Sheridan; M. Smye; E. R. Trimble; D. Coustan; D. R. Hadden; M. Hod; L. P. Lowe; J. J.N. Oats; B. Persson; E. R. Trimble; G. R. Cutter; S. G. Gabbe; J. W. Hare; L. E. Wagenknecht; Y. Chen; J. Claman; J. King

doi:10.1056/NEJMoa0707943

Hyperglycemia and adverse pregnancy outcomes

Boyd E. Metzger^*, M. Contreras, D. A. Sacks, W. Watson, S. L. Dooley, M. Foderaro, C. Niznik, J. Bjaloncik, P. M. Catalano, L. Dierker, S. Fox, L. Gullion, C. Johnson, C. A. Lindsay, H. Makovos, F. Saker, M. W. Carpenter, J. Hunt, M. H. Somers, K. S. AmankwahP. C. Chan, B. Gherson, E. Herer, B. Kapur, A. Kenshole, G. Lawrence, K. Matheson, L. Mayes, K. McLean, H. Owen, C. Cave, G. Fenty, E. Gibson, A. Hennis, G. McIntyre, Y. E. Rotchell, C. Spooner, H. A.R. Thomas, J. Gluck, D. R. Hadden, H. Halliday, J. Irwin, O. Kearney, J. McAnee, D. R. McCance, M. Mousavi, A. I. Traub, J. K. Cruickshank, N. Derbyshire, J. Dry, A. C. Holt, F. Khan, C. Lambert, M. Maresh, F. Prichard, C. Townson, T. W. Van Haeften, A. M.R. Van De Hengel, G. H.A. Visser, A. Zwart, U. Chaovarindr, U. Chotigeat, C. Deerochanawong, I. Panyasiri, P. Sanguanpong, D. Amichay, A. Golan, K. Marks, M. Mazor, J. Ronen, A. Wiznitzer, R. Chen, D. Harel, N. Hoter, N. Melamed, J. Pardo, M. Witshner, Y. Yogev, F. Bowling, D. Cowley, P. Devenish-Meares, H. G. Liley, A. McArdle, H. D. McIntyre, B. Morrison, A. Peacock, A. Tremellen, D. Tudehope, K. Y. Chan, N. Y. Chan, L. W. Ip, S. L. Kong, Y. L. Lee, C. Y. Li, K. F. Ng, P. C. Ng, M. S. Rogers, K. W. Wong, M. Edgar, W. Giles, A. Gill, R. Glover, J. Lowe, F. Mackenzie, K. Siech, J. Verma, A. Wright, Y. H. Cao, J. J. Chee, A. Koh, E. Tan, V. J. Rajadurai, H. Y. Wee, G. S.H. Yeo, D. Coustan, B. Haydon, A. Alexander, D. R. Hadden, O. Attias-Raved, M. Hod, J. J.N. Oats, A. F. Parry, A. Collard, A. S. Frank, L. P. Lowe, A. Thomas, T. Case, P. Cholod, A. R. Dyer, L. Engelman, M. Xiao, L. Yang, C. I. Burgess, T. R.J. Lappin, G. S. Nesbitt, B. Sheridan, M. Smye, E. R. Trimble, D. Coustan, D. R. Hadden, M. Hod, L. P. Lowe, J. J.N. Oats, B. Persson, E. R. Trimble, G. R. Cutter, S. G. Gabbe, J. W. Hare, L. E. Wagenknecht, Y. Chen, J. Claman, J. King

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4412 Scopus citations

Abstract

BACKGROUND: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS: A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS: For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker. CONCLUSIONS: Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.

Original language	English
Pages (from-to)	1991-2002
Number of pages	12
Journal	New England Journal of Medicine
Volume	358
Issue number	19
DOIs	https://doi.org/10.1056/NEJMoa0707943
State	Published - 8 May 2008

Funding

Funders	Funder number
National Center for Research Resources	UL1RR024989
National Center for Research Resources

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10.1056/NEJMoa0707943

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Metzger, B. E., Contreras, M., Sacks, D. A., Watson, W., Dooley, S. L., Foderaro, M., Niznik, C., Bjaloncik, J., Catalano, P. M., Dierker, L., Fox, S., Gullion, L., Johnson, C., Lindsay, C. A., Makovos, H., Saker, F., Carpenter, M. W., Hunt, J., Somers, M. H., ... King, J. (2008). Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine, 358(19), 1991-2002. https://doi.org/10.1056/NEJMoa0707943

@article{f2b8abe84b3e4512a183023d91e7bb17,

title = "Hyperglycemia and adverse pregnancy outcomes",

abstract = "BACKGROUND: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS: A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS: For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker. CONCLUSIONS: Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.",

author = "Metzger, {Boyd E.} and M. Contreras and Sacks, {D. A.} and W. Watson and Dooley, {S. L.} and M. Foderaro and C. Niznik and J. Bjaloncik and Catalano, {P. M.} and L. Dierker and S. Fox and L. Gullion and C. Johnson and Lindsay, {C. A.} and H. Makovos and F. Saker and Carpenter, {M. W.} and J. Hunt and Somers, {M. H.} and Amankwah, {K. S.} and Chan, {P. C.} and B. Gherson and E. Herer and B. Kapur and A. Kenshole and G. Lawrence and K. Matheson and L. Mayes and K. McLean and H. Owen and C. Cave and G. Fenty and E. Gibson and A. Hennis and G. McIntyre and Rotchell, {Y. E.} and C. Spooner and Thomas, {H. A.R.} and J. Gluck and Hadden, {D. R.} and H. Halliday and J. Irwin and O. Kearney and J. McAnee and McCance, {D. R.} and M. Mousavi and Traub, {A. I.} and Cruickshank, {J. K.} and N. Derbyshire and J. Dry and Holt, {A. C.} and F. Khan and C. Lambert and M. Maresh and F. Prichard and C. Townson and {Van Haeften}, {T. W.} and {Van De Hengel}, {A. M.R.} and Visser, {G. H.A.} and A. Zwart and U. Chaovarindr and U. Chotigeat and C. Deerochanawong and I. Panyasiri and P. Sanguanpong and D. Amichay and A. Golan and K. Marks and M. Mazor and J. Ronen and A. Wiznitzer and R. Chen and D. Harel and N. Hoter and N. Melamed and J. Pardo and M. Witshner and Y. Yogev and F. Bowling and D. Cowley and P. Devenish-Meares and Liley, {H. G.} and A. McArdle and McIntyre, {H. D.} and B. Morrison and A. Peacock and A. Tremellen and D. Tudehope and Chan, {K. Y.} and Chan, {N. Y.} and Ip, {L. W.} and Kong, {S. L.} and Lee, {Y. L.} and Li, {C. Y.} and Ng, {K. F.} and Ng, {P. C.} and Rogers, {M. S.} and Wong, {K. W.} and M. Edgar and W. Giles and A. Gill and R. Glover and J. Lowe and F. Mackenzie and K. Siech and J. Verma and A. Wright and Cao, {Y. H.} and Chee, {J. J.} and A. Koh and E. Tan and Rajadurai, {V. J.} and Wee, {H. Y.} and Yeo, {G. S.H.} and D. Coustan and B. Haydon and A. Alexander and Hadden, {D. R.} and O. Attias-Raved and M. Hod and Oats, {J. J.N.} and Parry, {A. F.} and A. Collard and Frank, {A. S.} and Lowe, {L. P.} and A. Thomas and T. Case and P. Cholod and Dyer, {A. R.} and L. Engelman and M. Xiao and L. Yang and Burgess, {C. I.} and Lappin, {T. R.J.} and Nesbitt, {G. S.} and B. Sheridan and M. Smye and Trimble, {E. R.} and D. Coustan and Hadden, {D. R.} and M. Hod and Lowe, {L. P.} and Oats, {J. J.N.} and B. Persson and Trimble, {E. R.} and Cutter, {G. R.} and Gabbe, {S. G.} and Hare, {J. W.} and Wagenknecht, {L. E.} and Y. Chen and J. Claman and J. King",

year = "2008",

month = may,

day = "8",

doi = "10.1056/NEJMoa0707943",

language = "אנגלית",

volume = "358",

pages = "1991--2002",

journal = "New England Journal of Medicine",

issn = "0028-4793",

publisher = "Massachussetts Medical Society",

number = "19",

}

Metzger, BE, Contreras, M, Sacks, DA, Watson, W, Dooley, SL, Foderaro, M, Niznik, C, Bjaloncik, J, Catalano, PM, Dierker, L, Fox, S, Gullion, L, Johnson, C, Lindsay, CA, Makovos, H, Saker, F, Carpenter, MW, Hunt, J, Somers, MH, Amankwah, KS, Chan, PC, Gherson, B, Herer, E, Kapur, B, Kenshole, A, Lawrence, G, Matheson, K, Mayes, L, McLean, K, Owen, H, Cave, C, Fenty, G, Gibson, E, Hennis, A, McIntyre, G, Rotchell, YE, Spooner, C, Thomas, HAR, Gluck, J, Hadden, DR, Halliday, H, Irwin, J, Kearney, O, McAnee, J, McCance, DR, Mousavi, M, Traub, AI, Cruickshank, JK, Derbyshire, N, Dry, J, Holt, AC, Khan, F, Lambert, C, Maresh, M, Prichard, F, Townson, C, Van Haeften, TW, Van De Hengel, AMR, Visser, GHA, Zwart, A, Chaovarindr, U, Chotigeat, U, Deerochanawong, C, Panyasiri, I, Sanguanpong, P, Amichay, D, Golan, A, Marks, K, Mazor, M, Ronen, J, Wiznitzer, A, Chen, R, Harel, D, Hoter, N, Melamed, N, Pardo, J, Witshner, M, Yogev, Y, Bowling, F, Cowley, D, Devenish-Meares, P, Liley, HG, McArdle, A, McIntyre, HD, Morrison, B, Peacock, A, Tremellen, A, Tudehope, D, Chan, KY, Chan, NY, Ip, LW, Kong, SL, Lee, YL, Li, CY, Ng, KF, Ng, PC, Rogers, MS, Wong, KW, Edgar, M, Giles, W, Gill, A, Glover, R, Lowe, J, Mackenzie, F, Siech, K, Verma, J, Wright, A, Cao, YH, Chee, JJ, Koh, A, Tan, E, Rajadurai, VJ, Wee, HY, Yeo, GSH, Coustan, D, Haydon, B, Alexander, A, Hadden, DR, Attias-Raved, O, Hod, M, Oats, JJN, Parry, AF, Collard, A, Frank, AS, Lowe, LP, Thomas, A, Case, T, Cholod, P, Dyer, AR, Engelman, L, Xiao, M, Yang, L, Burgess, CI, Lappin, TRJ, Nesbitt, GS, Sheridan, B, Smye, M, Trimble, ER, Coustan, D, Hadden, DR, Hod, M, Lowe, LP, Oats, JJN, Persson, B, Trimble, ER, Cutter, GR, Gabbe, SG, Hare, JW, Wagenknecht, LE, Chen, Y, Claman, J & King, J 2008, 'Hyperglycemia and adverse pregnancy outcomes', New England Journal of Medicine, vol. 358, no. 19, pp. 1991-2002. https://doi.org/10.1056/NEJMoa0707943

TY - JOUR

T1 - Hyperglycemia and adverse pregnancy outcomes

AU - Metzger, Boyd E.

AU - Contreras, M.

AU - Sacks, D. A.

AU - Watson, W.

AU - Dooley, S. L.

AU - Foderaro, M.

AU - Niznik, C.

AU - Bjaloncik, J.

AU - Catalano, P. M.

AU - Dierker, L.

AU - Fox, S.

AU - Gullion, L.

AU - Johnson, C.

AU - Lindsay, C. A.

AU - Makovos, H.

AU - Saker, F.

AU - Carpenter, M. W.

AU - Hunt, J.

AU - Somers, M. H.

AU - Amankwah, K. S.

AU - Chan, P. C.

AU - Gherson, B.

AU - Herer, E.

AU - Kapur, B.

AU - Kenshole, A.

AU - Lawrence, G.

AU - Matheson, K.

AU - Mayes, L.

AU - McLean, K.

AU - Owen, H.

AU - Cave, C.

AU - Fenty, G.

AU - Gibson, E.

AU - Hennis, A.

AU - McIntyre, G.

AU - Rotchell, Y. E.

AU - Spooner, C.

AU - Thomas, H. A.R.

AU - Gluck, J.

AU - Hadden, D. R.

AU - Halliday, H.

AU - Irwin, J.

AU - Kearney, O.

AU - McAnee, J.

AU - McCance, D. R.

AU - Mousavi, M.

AU - Traub, A. I.

AU - Cruickshank, J. K.

AU - Derbyshire, N.

AU - Dry, J.

AU - Holt, A. C.

AU - Khan, F.

AU - Lambert, C.

AU - Maresh, M.

AU - Prichard, F.

AU - Townson, C.

AU - Van Haeften, T. W.

AU - Van De Hengel, A. M.R.

AU - Visser, G. H.A.

AU - Zwart, A.

AU - Chaovarindr, U.

AU - Chotigeat, U.

AU - Deerochanawong, C.

AU - Panyasiri, I.

AU - Sanguanpong, P.

AU - Amichay, D.

AU - Golan, A.

AU - Marks, K.

AU - Mazor, M.

AU - Ronen, J.

AU - Wiznitzer, A.

AU - Chen, R.

AU - Harel, D.

AU - Hoter, N.

AU - Melamed, N.

AU - Pardo, J.

AU - Witshner, M.

AU - Yogev, Y.

AU - Bowling, F.

AU - Cowley, D.

AU - Devenish-Meares, P.

AU - Liley, H. G.

AU - McArdle, A.

AU - McIntyre, H. D.

AU - Morrison, B.

AU - Peacock, A.

AU - Tremellen, A.

AU - Tudehope, D.

AU - Chan, K. Y.

AU - Chan, N. Y.

AU - Ip, L. W.

AU - Kong, S. L.

AU - Lee, Y. L.

AU - Li, C. Y.

AU - Ng, K. F.

AU - Ng, P. C.

AU - Rogers, M. S.

AU - Wong, K. W.

AU - Edgar, M.

AU - Giles, W.

AU - Gill, A.

AU - Glover, R.

AU - Lowe, J.

AU - Mackenzie, F.

AU - Siech, K.

AU - Verma, J.

AU - Wright, A.

AU - Cao, Y. H.

AU - Chee, J. J.

AU - Koh, A.

AU - Tan, E.

AU - Rajadurai, V. J.

AU - Wee, H. Y.

AU - Yeo, G. S.H.

AU - Coustan, D.

AU - Haydon, B.

AU - Alexander, A.

AU - Hadden, D. R.

AU - Attias-Raved, O.

AU - Hod, M.

AU - Oats, J. J.N.

AU - Parry, A. F.

AU - Collard, A.

AU - Frank, A. S.

AU - Lowe, L. P.

AU - Thomas, A.

AU - Case, T.

AU - Cholod, P.

AU - Dyer, A. R.

AU - Engelman, L.

AU - Xiao, M.

AU - Yang, L.

AU - Burgess, C. I.

AU - Lappin, T. R.J.

AU - Nesbitt, G. S.

AU - Sheridan, B.

AU - Smye, M.

AU - Trimble, E. R.

AU - Coustan, D.

AU - Hadden, D. R.

AU - Hod, M.

AU - Lowe, L. P.

AU - Oats, J. J.N.

AU - Persson, B.

AU - Trimble, E. R.

AU - Cutter, G. R.

AU - Gabbe, S. G.

AU - Hare, J. W.

AU - Wagenknecht, L. E.

AU - Chen, Y.

AU - Claman, J.

AU - King, J.

PY - 2008/5/8

Y1 - 2008/5/8

N2 - BACKGROUND: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS: A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS: For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker. CONCLUSIONS: Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.

AB - BACKGROUND: It is controversial whether maternal hyperglycemia less severe than that in diabetes mellitus is associated with increased risks of adverse pregnancy outcomes. METHODS: A total of 25,505 pregnant women at 15 centers in nine countries underwent 75-g oral glucose-tolerance testing at 24 to 32 weeks of gestation. Data remained blinded if the fasting plasma glucose level was 105 mg per deciliter (5.8 mmol per liter) or less and the 2-hour plasma glucose level was 200 mg per deciliter (11.1 mmol per liter) or less. Primary outcomes were birth weight above the 90th percentile for gestational age, primary cesarean delivery, clinically diagnosed neonatal hypoglycemia, and cord-blood serum C-peptide level above the 90th percentile. Secondary outcomes were delivery before 37 weeks of gestation, shoulder dystocia or birth injury, need for intensive neonatal care, hyperbilirubinemia, and preeclampsia. RESULTS: For the 23,316 participants with blinded data, we calculated adjusted odds ratios for adverse pregnancy outcomes associated with an increase in the fasting plasma glucose level of 1 SD (6.9 mg per deciliter [0.4 mmol per liter]), an increase in the 1-hour plasma glucose level of 1 SD (30.9 mg per deciliter [1.7 mmol per liter]), and an increase in the 2-hour plasma glucose level of 1 SD (23.5 mg per deciliter [1.3 mmol per liter]). For birth weight above the 90th percentile, the odds ratios were 1.38 (95% confidence interval [CI], 1.32 to 1.44), 1.46 (1.39 to 1.53), and 1.38 (1.32 to 1.44), respectively; for cord-blood serum C-peptide level above the 90th percentile, 1.55 (95% CI, 1.47 to 1.64), 1.46 (1.38 to 1.54), and 1.37 (1.30 to 1.44); for primary cesarean delivery, 1.11 (95% CI, 1.06 to 1.15), 1.10 (1.06 to 1.15), and 1.08 (1.03 to 1.12); and for neonatal hypoglycemia, 1.08 (95% CI, 0.98 to 1.19), 1.13 (1.03 to 1.26), and 1.10 (1.00 to 1.12). There were no obvious thresholds at which risks increased. Significant associations were also observed for secondary outcomes, although these tended to be weaker. CONCLUSIONS: Our results indicate strong, continuous associations of maternal glucose levels below those diagnostic of diabetes with increased birth weight and increased cord-blood serum C-peptide levels.

UR - http://www.scopus.com/inward/record.url?scp=43249096940&partnerID=8YFLogxK

U2 - 10.1056/NEJMoa0707943

DO - 10.1056/NEJMoa0707943

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AN - SCOPUS:43249096940

SN - 0028-4793

VL - 358

SP - 1991

EP - 2002

JO - New England Journal of Medicine

JF - New England Journal of Medicine

IS - 19

ER -

Hyperglycemia and adverse pregnancy outcomes

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UN SDGs

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