This was a 7 -year international epidemiological study of 23,325 pregnant women at 15 centers in nine countries (HAPO Study Cooperative Research Group, 2008). The investigation analyzed the association of various levels of glucose intolerance during the third trimester with adverse infant outcomes in women with gestational diabetes. Between 24 and 32 weeks' gestation, the general population of pregnant women underwent a 75-g OGTT after an overnight fasting. Blood glucose levels were measured fasting and then 1 and 2 hours after glucose ingestion. Caregivers were blinded to results except for women whose glucose levels exceeded values that required treatment and removal from the study. Glucose values at each of these three time posts were stratiied into seven categories (Fig. 57-6). hese values were then correlated with rates for birthweight >90th percentile (LGA) , primary cesarean delivery, neonatal hypoglycemia, and cord-serum C-peptide levels >90th percentile. Odds of each outcome were calculated using the lowest category-for example, fasting plasma glucose :;75 mg/dL-as the referent group. Their indings in general supported the supposition that increasing plasma glucose levels were associated with increasing adverse outcomes. Ecker and diagnosis rates but not with reduced macrosomia rates compared with a twostep approach. Remarkably, they identi � rate associated with adoption of the : IADPSG recommendations. he ADA ) (2013, 2017a) initially recommended ) adopting this new approach, however, ..J,approach described on page 1108, they now concede that data support a twostep strategy as well.
-1hour ; 105 106-132 133-155 156-171 172-193 194-211 ::212 Prompted by the disparate recommen -2hour ; 9091-108 109-125 126-139 140-157 158-177 ::178 dations, the NIH Consensus Development Conference on Diagnosing
FIGURE 57-6 Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. The fre quency of newborn birthweight ::90th percentile for gestational age plotted against glucose was convened. his conference included levels fasting and at 1-and 2-hr intervals following a 75-g oral glucose load. LGA = large for gestational age. (Reproduced with permission from HAPO Study Cooperative Research input from a multidisciplinary planning Group, Metzger BE, Lowe LP, et al: Hyperglycemia and adverse pregnancy outcomes, N Engl committee, a systematic evidence review
J Med. 2008 May 8;358(19):1991-2002.)
Greene (2008) concluded that it would be diicult to show that treating lesser degrees of carbohydrate intolerance would provide any meaningful improvements in clinical outcomes. We agree that changes in criteria are not justiied until clinical trials prove benefits. his position was also endorsed by the 2013 NIH Consensus Development Conference.