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The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy.

American Journal of Obstetrics and Gynecology (Impact Factor: 3.97). 10/1987; 157(3):758-63. DOI: 10.1016/0020-7292(88)90066-5
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ABSTRACT A matched control study of 126 women equally divided into three groups (normal oral glucose tolerance test, one abnormal test value, and gestational diabetes mellitus) was undertaken to examine the relationships among oral glucose tolerance test results, glycemic control in pregnancy, and adverse perinatal outcome. Characterization of metabolic control for the one abnormal oral glucose tolerance test value and the gestational diabetes mellitus groups (before treatment) showed no significant difference. After the start of treatment, however, a significant (p less than 0.01) difference between the groups in level of control was found. While no significant difference in the average birth weight between the three groups was discovered, the incidence of large infants (macrosomia and large for gestational age) was found to be significantly higher in the one abnormal oral glucose tolerance test group when compared with the normal (34% versus 9%; p less than 0.01) and gestational diabetes mellitus group (34% versus 12%; p less than 0.01). No significant difference for the incidence of an infant large for gestational age was found between the normal group and the patients with gestational diabetes mellitus after treatment. Neonatal metabolic disorders were found to be significantly higher for the one abnormal oral glucose tolerance test group (15%) when compared with the control and the gestational diabetes mellitus groups (3%). We conclude that, if left untreated, one abnormal value on an oral glucose tolerance test is strongly associated with adverse perinatal outcome.

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    • "A cohort of 81 women, three years after a pregnancy complicated by GDM (diagnosed through Carpenter & Coustan Criteria) [9], with negative anti GAD antibodies at diagnosis, was evaluated according to their breastfeeding habits. Also patients with just one altered value in the OGTT [defined OAV ( " one abnormal value " )] had been considered [10]. None of the women was treated with medications and/or substances potentially conditioning metabolism at the moment of follow up. "
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    • "In the Toronto Tri-Hospital Study, women who had ''borderline'' GDM (met Carpenter and Coustan's criteria but not NDDG criteria) were not treated as diabetic and had more than twice the rate of macrosomia as women who had normal glucose testing (28% versus 13%) [21]. Similarly, women who had one abnormal value (using the higher NDDG criteria) also had increased rates of overgrown infants [22]. In the past, it was suggested that a carbohydrate loading period of 3 days should precede the 3-hour GTT to ''prime'' the pancreas for the GTT and, thereby, reduce false positive results. "
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    ABSTRACT: Diabetes, whether existing before pregnancy or brought on by changes in maternal physiology, poses risks to the mother and developing fetus. Excellent preconceptional and pregnancy care can help to minimize, or even to eliminate, these risks. This article reviews the problems that are associated with diabetes in pregnancy and evidence-based strategies to avoid them.
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    • "The degree of glucose intolerance varies considerably, from slightly impaired glucose tolerance (IGT) to overt diabetes requiring insulin treatment. Some studies have also convincingly indicated that there is an association between glucose intolerance and maternal as well as perinatal complications, in particular fetal macrosomia and resultant shoulder dystocia, and cesarean delivery (Langer et al. 1987; Sermer et al. 1995; Aberg, Rydhstroem et al. 2001). Very few prospective studies on GDM have been carried out, and virtually no randomized controlled data for subjects in whom GDM is left untreated are available. "
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