ABSTRACT Objective: We adopted the area under the curve (AUC) of oral
glucose tolerance test (OGTT) as a measure method of the severity of maternal
hyperglycemia and investigated its relationship with adverse perinatal outcomes
among women with and without gestational diabetes mellitus (GDM). Research
design and methods:This is a retrospective cohort
study. Our study group collected the medical records of 15,296 women who
received perinatal care in 15 hospitals in
Beijing and who delivered from July 1, 2013, to December 31, 2013. And several
original articles on this cohort have been published. In this study, we analyze the relationship between
AUC and adverse perinatal outcomes, so that in multiple
pregnant cases, patients with pre-pregnancy diabetes,
hypertension, and abnormal kidney function and those who did not receive a 75-g OGTT were
excluded. A Chi-squared test and logistic regression analysis were used to determine the
associations. Results: In total, 13,561 women were included. As the AUC
of OGTT increased, the prevalence of macrosomia (odds ratio [OR] 1.059, 95%confidence interval [95% CI]
1.029 - 1.090, p < 0.001) and hypertensive diseases (OR 1.106, 95% CI 1.064 -
1.149, p < 0.001) also increased. For patients with same levels of AUC
values, no significant differences in the risk of macrosomia, preterm birth and
neonatal complications were observed between the GDM and non-GDM groups. Women with an AUC higher than 14.20 (mmol*h/L) had a higher risk of adverse outcomes regardless of the presence of
GDM. Conclusions: TheAUC could be a
measure method of the severity of maternal hyperglycemia, and women with a high
AUC should undergo aggressive management to avoid adverse outcomes regardless
of the presence of GDM.
Cite this paper
Zhang, C. , Wei, Y. , Sun, W. and Yang, H. (2019) The Area under the Curve (AUC) of Oral Glucose Tolerance Test (OGTT) Could Be a Measure Method of Hyperglycemia in All Pregnant Women. Open Journal of Obstetrics and Gynecology, 9, 186-195. doi: 10.4236/ojog.2019.92019.
 Zhu, W.W., Yang, H.X., Wei, Y.M., Yan, J., Wang, Z.L., Li, X.L., et al. (2013) Evaluation of the Value of Fasting Plasma Glucose in the First Prenatal Visit to Diagnose Gestational Diabetes Mellitus in China. Diabetes Care, 36, 586-590.
 Zhu, W.W., Yang, H.X., Wang, C., Su, R.N., Feng, H. and Kapur, A. (2017) High Prevalence of Gestational Diabetes in Beijing: Effect of Maternal Birth Weight and Other Risk Factors. Chinese Medical Journal, 130, 1019-1125.
 Song, G., Wei, Y.M., Zhu, W.W. and Yang, H.X. (2017) Cesarean Section Rate in Singleton Primiparae and Related Factors in Beijing, China. Chinese Medical Journal, 130, 2395-2401. https://doi.org/10.4103/0366-6999.216415
 Zhu, Y.C., Yang, H.X., Wei, Y.M., et al. (2017) Analysis of Correlation Factors and Pregnancy Outcomes of Hypertensive Disorders of Pregnancy—A Second Analysis of a Random Sampling in Beijing, China. The Journal of Maternal-Fetal & Neonatal Medicine, 30, 751-754. https://doi.org/10.1080/14767058.2016.1186161
 HAPO Study Cooperative Research Group (2008) Hyperglycemia and Adverse Pregnancy Outcomes. The New England Journal of Medicine, 358, 1991-2002.
 International Association of Diabetes Pregnancy Study Groups Consensus Panel (2010) International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care, 33, 676-682. https://doi.org/10.2337/dc09-1848
 Feng, H., Zhu, W.W., Yang, H.X., Wei, Y.M., Wang, C., Su, R.N., et al. (2017) Relationship between Oral Glucose Tolerance Test Characteristics and Adverse Pregnancy Outcomes among Women with gestational Diabetes Mellitus. Chinese Medical Journal, 130, 1012-1018. https://doi.org/10.4103/0366-6999.204928
 Zhang, C.Y., Su, S.P. and Yang, H.X. (2015) Impact of Area under the Curve of Oral Glucose Tolerance Test on Pregnant Women with Gestational Diabetes Mellitus. Chinese Journal of Obstetrics and Gynecology, 50, 658-663.
 Yang, H.X. (2012) Diagnostic Criteria for Gestational Diabetes Mellitus (WS 331-2011). Chinese Medical Journal, 125, 1212-1213.
 American College of Obstetricians and Gynecologists (2013) Hypertension in Pregnancy. Obstetrics & Gynecology, 122, 1122-1131.
 Bhutani, V.K., Johnson, L. and Sivieri, E.M. (1999) Predictive Ability of a Predischarge Hour-Specific Serum Bilirubin for Subsequent Significant Hyperbilirubinemia in Healthy Term and Near-Term Newborns. Pediatrics, 103, 6-14.
 Rudland, V.L., Hinchcliffe, M., Pinner, J., Cole, S., Mercorella, B., Molyneaux, L., et al. (2016) Identifying Glucokinase Monogenic Diabetes in a Multiethnic Gestational Diabetes Mellitus Cohort: New Pregnancy Screening Criteria and Utility of HbA1c. Diabetes Care, 39, 50-52. https://doi.org/10.2337/dc15-1001
 Hashimoto, K. and Koga, M. (2015) Indicators of Glycemic Control in Patients with Gestational Diabetes Mellitus and Pregnant Women with Diabetes Mellitus. World Journal of Diabetes, 6, 1045-1056. https://doi.org/10.4239/wjd.v6.i8.1045
 Kim, S., Min, W.K., Chun, S., et al. (2009) Quantitative Risk Estimation for Large for Gestational Age Using the Area under the 100-g Oral Glucose Tolerance Test Curve. Journal of Clinical Laboratory Analysis, 23, 231-236.
 Goldstein, R.F., Abell, S.K., Ranasinha, S., Misso, M., Boyle, J.A., Black, M.H., et al. (2017) Association of Gestational Weight Gain with Maternal and Infant Outcomes: A Systematic Review and Meta-Analysis. JAMA, 317, 2207-2225.
 Harper, L.M., Tita, A. and Biggio, J.R. (2015) The Institute of Medicine Guidelines for Gestational Weight Gain after a Diagnosis of Gestational Diabetes and Pregnancy Outcomes. American Journal of Perinatology, 32, 239-246.
 Wei, Y.M., Yang, H.X., Zhu, W.W., Yang, H.Y., Li, H.X. and Kapur, A. (2015) Effects of Intervention to Mild GDM on Outcomes. The Journal of Maternal-Fetal & Neonatal Medicine, 28, 928-931. https://doi.org/10.3109/14767058.2014.937697
 Carolan, O.M.C. (2016) Educational and Intervention Programmes for Gestational Diabetes Mellitus (GDM) Management: An Integrative Review. Collegian, 23, 103-114. https://doi.org/10.1016/j.colegn.2015.01.001
 Poolsup, N., Suksomboon, N. and Amin, M. (2014) Effect of Treatment of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis. PLoS ONE, 9, e92485.
 Spradley, F.T. (2017) Metabolic Abnormalities and Obesity’s Impact on the Risk for Developing Preeclampsia. American Journal of Physiology-Regulatory Integrative and Comparative Physiology, 312, R5-R12.
 Kun, A. (2011) Insulin Resistance Is Associated with Gestational Hypertension and Not with Preeclampsia: A Population-Based Screening Study. Gynecologic and Obstetric Investigation, 71, 256-261. https://doi.org/10.1159/000320326
 Kayemba-Kay’s, S., Peters, C., Geary, M.P., Hill, N.R., Mathews, D.R. and Hindmarsh, P.C. (2013) Maternal Hyperinsulinism and Glycaemic Status in the First Trimester of Pregnancy Are Associated with the Development of Pregnancy-Induced Hypertension and Gestational Diabetes. European Journal of Endocrinology, 168, 413-418. https://doi.org/10.1530/EJE-12-0609
 Howell, K.R. and Powell, T.L. (2017) Effects of Maternal Obesity on Placental Function and Fetal Development. Reproduction, 153, R97.
 Li, N., Liu, E., Guo, J., Pan, L., Li, B., Wang, P., et al. (2013) Maternal Pre-Pregnancy Body Mass Index and Gestational Weight Gain on Pregnancy Outcomes. PLoS ONE, 8, e82310.
 Wei, Y.M., Yang, H.X., Zhu, W.W., Liu, X.Y., Meng, W.Y., Wang, Y.Q., et al. (2016) Risk of Adverse Pregnancy Outcomes Stratified for Pre-Pregnancy Body Mass Index. The Journal of Maternal-Fetal & Neonatal Medicine, 29, 2205-2209.
 Billionnet, C., Mitanchez, D., Weill, A., et al. (2017) Gestational Diabetes and Adverse Perinatal Outcomes from 716,152 Births in France in 2012. Diabetologia, 60, 636. https://doi.org/10.1007/s00125-017-4206-6
 Catalano, P.M. and Shankar, K. (2017) Obesity and Pregnancy: Mechanisms of Short Term and Long Term Adverse Consequences for Mother and Child. BMJ, 356, j1.