OBJECTIVE -To evaluate whether there is increased maternal or neonatal morbidity in connection with impaired glucose tolerance (IGT) during pregnancy when the condition is not treated.
RESEARCH DESIGN AND METHODS-During the study period of 1997-2001, in a defined geographical area in Sweden, the diagnostic criteria for gestational diabetes mellitus (GDM) were limited to the criteria for diabetes. Prospectively, 213 women who were identified with IGT during pregnancy were undiagnosed and untreated. Data on maternal and fetal outcome was collected from records. For each case subject, four control subjects were taken from the same delivery department.RESULTS -The proportion of women who underwent cesarean section was significantly higher in the case subjects than in the control subjects and was independently associated with IGT. The adjusted odds ratio (OR) was 1.9 (95% CI 1.2-2.9). The proportion of infants who were large for gestational age (LGA), defined as birth weight Ͼ2 SDs greater than the mean for gestation and sex, was independently significantly associated with untreated IGT during pregnancy (OR 7.3, 95% CI 4.1-12.7). Admission to a neonatal intensive care unit (NICU) for 2 days or longer was more common (adjusted OR 2.0, 95% CI 1.1-3.8). However, 71.3% of the children in the IGT group and 87.3% of the control subjects had no neonatal complications.CONCLUSIONS -There is increased independent association between cesarean section rate, prematurity, LGA, and macrosomic infants born to mothers with untreated IGT. Most of the children were healthy, but there is still increased morbidity. Therefore, to evaluate the effects of treatment, there is a need for a randomized study.
Diabetes Care 26:2107-2111, 2003G estational diabetes mellitus (GDM) is defined as carbohydrate intolerance of varying degrees of severity with onset or first recognition during pregnancy (1). Originally, the purpose of identifying GDM was the prediction of diabetes later in life (2). Observations that GDM may be associated with an increased risk of fetal malformation and perinatal mortality are likely to be confined to a subgroup of patients with GDM in whom diabetes was present but unrecognized before pregnancy (3,4). Later, the main purpose was to detect women at risk for adverse perinatal outcomes, such as macrosomia, birth trauma, neonatal metabolic abnormalities, and cesarean section (5). In the past decade, however, screening for GDM has been strongly questioned because of the lack of convincing data regarding the possibility to improve these outcomes. Risks associated with GDM have also been attributed to confounding characteristics such as obesity, advanced maternal age, or other medical complications, rather than to the glucose intolerance per se. Identification of impaired glucose tolerance (IGT) during pregnancy has especially been questioned (6 -8).Maternal and fetal complications associated with GDM are often reported from observational studies in which GDM is identified and treated in different ways (9 -11). There is, howeve...
