Gestational Diabetes

GDM: Abnormal Glucose Tolerance During Pregnancy (2008)

• Assessment
  What is the relationship between impaired glucose tolerance and poor outcomes in pregnant women?

  • Conclusion

    Twenty studies were evaluated to investigate the relationship between impaired glucose tolerance (definitions vary) during pregnancy and poor outcomes.  Two studies demonstrate the metabolic similarities between impaired glucose tolerance and gestational diabetes mellitus.  Twelve studies report increased risks of large for gestational age newborns and macrosomia in women with impaired glucose tolerance.  Additional research notes increased risks of preterm birth, perinatal morbidity and neonatal hypoglycemia.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Relationship between impaired glucose tolerance during pregnancy and poor outcomes
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Aberg A, Rydhstroem H, Frid A. Impaired glucose tolerance associated with adverse pregnancy outcome: A population-based study in southern Sweden. Am J Obstet Gynecol 2001;184:77-83.
      • Bo S, Menato G, Gallo M, Bardelli C, Lezo A, Signorile A, Gambino R, Cassader M, Massobrio M and Pagano G. Mild gestational hyperglycemia, the metabolic syndrome and adverse neonatal outcomes. Acta Obstet Gynecol Scand 2004; 83(4):335-40.
      • Bonomo M, Corica D, Mion E, Goncalves D, Motta G, Merati R, Ragusa A, Morabito A. Evaluating the therapeutic approach in pregnancies complicated by borderline glucose intolerance: a randomized clinical trial. Diabet Med 2005;22:1536-1541.
      • Ergin T, Lembet A, Duran H, Kuscu E, Bagis T, Saygili E, Batioglu S. Does insulin secretion in patients with one abnormal glucose tolerance test value mimic gestational diabetes mellitus? Am J Obstet Gynecol 2002; 186(2):204-209.
      • Gruendhammer M, Brezinka C, Lechleitner M. The number of abnormal plasma glucose values in the oral glucose tolerance test and the feto-maternal outcome of pregnancy. Eur J of Obstet and Gynecol Reproductive Biology 2003; 108(2):131-136. 
      • Hedderson MM, Ferrara A, Sacks DA. Gestational Diabetes Mellitus and Lesser Degrees of Pregnancy Hyperglycemia: Association With Increased Risk of Spontaneous Birth. Obstetrics & Gynecology 2003;102:850-856.   
      • Jensen DM, Damm P, Sorensen B, Molsted-Pedersen L, Westergaard JG, Klebe J, Beck-Nielsen H. Clinical impact of mild carbohydrate intolerance in pregnancy: A study of 2904 nondiabetic Danish women with risk factors for gestational diabetes mellitus. Am J Obstet Gynecol 2001;108(2):131-6.      
      • Jiménez-Moleón JJ, Bueno-Cavanillas A, Luna-del-Castillo J, García Màrtín M, Lardelli-Claret P, Gálvez-Vargas R. Impact of different levels of carbohydrate intolerance on neonatal outcomes classically associated with gestational diabetes. Eur J Obstet Gynecol Reprod Biol 2002;102(1):36-41. 
      • Lao TT, Ho LF. Perinatal Morbidity and Placental Size in Gestational Impaired Glucose Tolerance. J Soc Gynecol Investig 2001;8(6):347-350.
      • Lao TT, Ho LF. Does Maternal Glucose Intolerance Affect the Length of Gestation in Singleton Pregnancies? J Soc Gynecol Investig 2003;10(6):366-371.  
      • Lao TT, Wong KY. Perinatal Outcome in Large-for-Gestational Infants:  Is it influenced by gestational impaired glucose tolerance? The Journal of Reproductive Medicine 2002; 47(6):497-502. 
      • Nordin NM, Wei JWH, Naing NN, Symonds EM. Comparison of maternal-fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance. J Obstet Gynecol Res 2006; 32(1):107-114.
      • Ostlund I, Hanson U, Bjorklund A, Hjertberg R, Eva N, Nordlander E, Marja-Liisa S, Wager J. Maternal and Fetal Outcomes if Gestational Impaired Glucose Tolerance Is Not Treated. Diabetes Care 2003;26(7):2107-2111.
      • Parretti E, Carignani L, Cioni R, Bartoli E, Borri P, Torre PL, Mecacci F, Martini E, Scarselli G, Mello G. Sonographic Evaluation of Fetal Growth and Body Composition in Women With Different Degrees of Normal Glucose Metabolism. Diabetes Care 2003;26(10):2741-2748.
      • Retnakaran R, Zinman B, Connelly PW, Sermer M, Hanley AJG. Impaired Glucose Tolerance of Pregnancy Is a Heterogeneous Metabolic Disorder as Defined by the Glycemic Response to the Oral Glucose Tolerance Test. Diabetes Care 2006;29(1):57-62.
      • Saldana TM, Siega-Riz AM, Adair LS, Savitz DA and Thorp JM. The Association Between Impaired Glucose Tolerance and Birth Weight Among Black and White Women in Central North Carolina. Diabetes Care 2003;26(3):656-661.   
      • Schaefer-Graf UM, Kjos SL, Kilavuz O, Plagemann A, Brauer M, Dudenhausen JW, Vetter K. Determinants of Fetal Growth at Different Periods of Pregnancies Complicated by Gestational Diabetes Mellitus or Impaired Glucose Tolerance. Diabetes Care 2003;26(1):193- 198.
      • Tuffnell DJ, West J, Walkinshaw SA. Treatments for gestational diabetes and impaired glucose tolerance in pregnancy. Cochrane Database Syst Rev 2003; (3):CD003395.
      • Vambergue A, Nuttens MC, Verier-Mine O, Dognin C, Cappoen JP and Fontaine P. Is mild gestational hyperglycemia associated with maternal and neonatal complications? The Diagest Study. British Diabetic Association. Diabetes Medicine 2000;17: 203-208. 
      • Yang X, Hsu-Hage B, Zhang H, Zhang C, Zhang Y, Zhang C. Women With Impaired Glucose Tolerance During Pregnancy Have Significantly Poor Pregnancy Outcomes. Diabetes Care 2002; 25:1619-1624.
  • Search Plan and Results: IGT and Poor Outcomes 2006