The following is a summary of “Neonatal outcomes according to different glucose threshold values in gestational diabetes: a register-based study,” published in the April 2024 issue of Obstetrics and Gynaecology by Kariniemi et al.
Mild hyperglycemia during pregnancy is often linked to elevated birth weight, but its broader impact on neonatal outcomes remains uncertain. In this study, the researchers sought to investigate the associations between untreated mild hyperglycemia, as determined by varying oral glucose tolerance test (OGTT) thresholds, and neonatal outcomes.
For the investigation, investigators conducted a comprehensive register-based study encompassing 4,939 singleton pregnant women who underwent a 75 g 2-hour OGTT across six delivery hospitals in Finland in 2009. Utilizing Finnish diagnostic thresholds for gestational diabetes mellitus (GDM), the study group identified women who did not meet these criteria but fell within the parameters outlined by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) or the National Institute for Health and Clinical Excellence (NICE). These women were categorized as having mild untreated hyperglycemia. Additionally, women who met both the Finnish and IADPSG or NICE criteria were designated as treated GDM groups, while normoglycemic women served as controls. The primary focus was on analyzing adverse neonatal outcomes, such as neonatal hypoglycemia, hyperbilirubinemia, birth trauma, or perinatal mortality, through multivariate logistic regression.
The findings revealed that the risk of adverse neonatal outcomes did not exhibit an increase in cases of mild untreated hyperglycemia compared to normoglycemic controls. Furthermore, this risk was notably lower than in the treated GDM groups. Specifically, utilizing the IADPSG criteria, the adjusted odds ratio (aOR) was 1.01 (95% CI: 0.71–1.44), while using the NICE criteria, the aOR was 1.05 (95% CI: 0.60–1.85). Intriguingly, this risk was significantly lower when compared to the treated IADPSG (aOR 0.38, 95% CI 0.27–0.53) or the treated NICE group (aOR 0.32, 95% CI 0.18–0.57).
In conclusion, the study suggests that the risk of adverse neonatal outcomes does not escalate in cases of mild untreated hyperglycemia compared to normoglycemic controls. Additionally, utilizing OGTT cut-offs of 5.3 mmol/L at fasting and 8.6 mmol/L at 2 hours effectively identifies clinically relevant GDM cases without overlooking neonates at risk for adverse outcomes.
Source: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06473-4