Does reactive hypoglycemia during the 100 g oral glucose tolerance test adversely affect perinatal outcomes?
Abstract
Objectives: To determine whether pregnant women who have reactive hypoglycemia during the 100 g oral glucose tolerance test (OGTT) are at an increased risk of poor pregnancy outcomes.
Material and methods: We retrospectively analyzed perinatal data from 413 women who underwent a 3 h OGTT at 24–28 weeks of gestation and gave birth in our clinics between January 2012 and December 2014.
Results: According to OGTT results, the majority of the subjects were normoglycemic (n = 316, 76.5%), while 49 (11.9%) were diagnosed with gestational diabetes, and 33 (8.0%) had single high glucose values. Reactive hypoglycemia was detected in only 15 patients (3.6%). The mean age of the women in the reactive hypoglycemia group was significantly lower than that of the women in the gestational diabetes and single high glucose value groups (26.4 ± 4.4 years, 31.4 ± 5.4 years, and 31.8 ± 4.3 years, respectively; p < 0.05). The newborns of the women in the reactive hypoglycemia group had higher rates of APGAR scores < 7, increased admission to the neonatal intensive care unit (NICU), and lower birth weights compared with the other groups (p < 0.001, p < 0.001, and p = 0.009, respectively).
Conclusion: Reactive hypoglycemia during the 3 h 100 g OGTT is significantly associated with low APGAR scores, low birth weights, and prenatal admission to the NICU. Therefore, pregnant women who develop hypoglycemia during the 100 g OGTT performed at 24–28 weeks of gestation should receive attentive follow-up care to decrease the possibility of adverse perinatal outcomes.
Keywords: Gestational diabetesoral glucose tolerance testperinatal outcomepregnancyreactive hypoglycemia
References
- Moyer VA. U.S. Preventive Services Task Force, U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008; 148(10): 759–765.
- Serlin DC, Lash RW. Diagnosis and management of gestational diabetes mellitus. Am Fam Physician. 2009; 80(1): 57–62.
- Weissman A, Solt I, Zloczower M, et al. Hypoglycemia during the 100-g oral glucose tolerance test: incidence and perinatal significance. Obstet Gynecol. 2005; 105(6): 1424–1428.
- Pugh SK, Doherty DA, Magann EF, et al. Does hypoglycemia following a glucose challenge test identify a high risk pregnancy? Reprod Health. 2009; 6: 10.
- Martín-Timón I, Del Cañizo-Gómez FJ. Mechanisms of hypoglycemia unawareness and implications in diabetic patients. World J Diabetes. 2015; 6(7): 912–926.
- Palardy J, Havrankova J, Lepage R, et al. Blood glucose measurements during symptomatic episodes in patients with suspected postprandial hypoglycemia. N Engl J Med. 1989; 321(21): 1421–1425.
- Lefèbvre PJ, Andreani D, Marks V, et al. Statement on post-prandial or reactive hypoglycaemia. Diabet Med. 1988; 5(2): 200–440.
- Field JB. Hypoglycemia. Definition, clinical presentations, classification, and laboratory tests. Endocrinol Metab Clin North Am. 1989; 18(1): 27–43.
- Brun JF, Fedou C, Mercier J. Postprandial reactive hypoglycemia. Diabetes Metab. 2000; 26(5): 337–351.
- Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998; 21 Suppl 2: B161–B167.
- Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose Intolerance. Diabetes. 1979; 28(12): 1039–1057.
- Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967; 71(2): 159–163.
- Esakoff TF, Cheng YW, Sparks TN, et al. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009; 200(6): 672.e1–672.e4.
- Plasencia W, Garcia R, Pereira S, et al. Criteria for screening and diagnosis of gestational diabetes mellitus in the first trimester of pregnancy. Fetal Diagn Ther. 2011; 30(2): 108–115.
- American Diabetes Association. Standards of medical care in diabetes--2009. Diabetes Care. 2009; 32 Suppl 1: S13–S61.
- Rani PR, Begum J. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. J Clin Diagn Res. 2016; 10(4): QE01–QE04.
- Roeckner JT, Sanchez-Ramos L, Jijon-Knupp R, et al. Single abnormal value on 3-hour oral glucose tolerance test during pregnancy is associated with adverse maternal and neonatal outcomes: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016; 215(3): 287–297.
- Benhalima K, Mathieu C, Van Assche A, et al. Survey by the European Board and College of Obstetrics and Gynaecology on screening for gestational diabetes in Europe. Eur J Obstet Gynecol Reprod Biol. 2016; 201: 197–202.
- Hernandez TL, Friedman JE, Van Pelt RE, et al. Patterns of glycemia in normal pregnancy: should the current therapeutic targets be challenged? Diabetes Care. 2011; 34(7): 1660–1668.
- Baz B, Riveline JP, Gautier JF. ENDOCRINOLOGY OF PREGNANCY: Gestational diabetes mellitus: definition, aetiological and clinical aspects. Eur J Endocrinol. 2016; 174(2): R43–R51.
- Eik W, Marcon SS, Krupek T, et al. Blood levels of pro-inflammatory and anti-inflammatory cytokines during an oral glucose tolerance test in patients with symptoms suggesting reactive hypoglycemia. Braz J Med Biol Res. 2016; 49(8).
- Berlin I, Grimaldi A, Landault C, et al. Suspected postprandial hypoglycemia is associated with beta-adrenergic hypersensitivity and emotional distress. J Clin Endocrinol Metab. 1994; 79(5): 1428–1433.
- Langer O, Damus K, Maiman M, et al. A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation. Am J Obstet Gynecol. 1986; 155(4): 711–716.
- Feinberg JH, Magann EF, Morrison JC, et al. Does maternal hypoglycemia during screening glucose assessment identify a pregnancy at-risk for adverse perinatal outcome? J Perinatol. 2005; 25(8): 509–513.
- Calfee EF, Rust OA, Bofill JA, et al. Maternal hypoglycemia: is it associated with adverse perinatal outcome? J Perinatol. 1999; 19(5): 379–382.