Outcome of Diabetes Screening in Pregnancy and Perinatal Morbidity in Infants of Mothers with Mild Impairment in Glucose Tolerance

Abstract

Pregnant women attending the regular prenatal clinic at Los Angeles County (LAC)/Women's Hospital received a 3-h oral glucose tolerance test (GTT). Upper limits for the test are a fasting blood glucose of 100 mg/dl (serum glucose 110 mg/dl), 1 h 170 mg/dl (200 mg/dl), 2 h 130 mg/dl (150 mg/dl), and 3 h 120 mg/dl (130 mg/dl). The incidence of overt diabetes (fasting hyperglycemia) was 3.5% and of Class A diabetic women (abnormal test but normal fasting glucose value) it was 8.8%. The incidence of abnormal tests is greater in obese patients, potential diabetic patients (family history of diabetes or abnormal obstetrical history), and with increasing age. However, it was 3.4% in a group of patients below age 20 yr and without an abnormal medical or obstetrical history. The perinatal mortality in uncomplicated Class A diabetic women is as low as in the general population. Patients with Complicated Class A (previous stillbirth or who develop preeclampsia) and those patients who develop fasting hyperglycemia should have medical and obstetrical surveillance. Twenty-five percent of the infants of Class A diabetic mothers experience some morbidity. Long-term follow-up of mothers with abnormal tests in pregnancy is indicated, since the incidence of subsequent carbohydrate abnormality is 40%. As a screening procedure, pregnant women should have a 2-h serum glucose following the administration of 100 g of a glucose solution. In patients with a value of over 140 mg/dl, a GTT should be performed. In patients with a screening value of less than 140 mg/dl, it should be repeated by 34 wk gestation.