Maternal and neonatal outcomes in early glucose tolerance testing in an obstetric population in New York city

Abstract

Women with risk factors for diabetes are screened early in pregnancy. At our institution we obtain a GCT (glucose challenge test) at first prenatal visit. We sought to compare pregnancy outcomes in women who were diagnosed with GDM early in pregnancy with those diagnosed at the standard 24-28 weeks' gestation. An inner city population receiving prenatal care from August 2003 to May 2007 participated in the study. Patients were screened during the first trimester when able (group 1) or during the standard 24-28 weeks' gestation (group 2). Patient demographics, maternal and neonatal outcome data were collected and analyzed. Of 340 GDM patients identified, 99 were diagnosed early and 241 at the standard time. Eighty per cent of group 2 were treated with diet alone and 20% required pharmacological therapy. Fifty per cent of group 1 were treated with diet and 45% with pharmacological therapy (P<0.001). Comparison between the early and late diagnosis groups for preterm delivery and hypertensive disorders were statistically non-significant. Cesarean delivery was 45% in group 1 and 24% in group 2. Both macrosomia (13% vs. 6%) and large-for-gestational-age (18% vs. 6%) was statistically higher in the early GTT group. The adverse perinatal outcome is significantly higher in the early diagnosis group despite early identification and management implying greater severity of GDM.