Objective This study aims to investigate the perinatal outcome of fetuses with polyhydramnios and/or accelerated growth among women with a normal oral glucose challenge test (oGCT). Methods Singleton, nonanomalous pregnancies with an oGCT(< 130 mg/dL) at 24 to 28 weeks, who subsequently demonstrate polyhydramnios (amniotic fluid index > 24 cm or maximum vertical pocket > 8 cm) and/or accelerated growth (abdominal circumference > 95th percentile) on two-third trimester examinations were studied. Maternal demographics, delivery, and neonatal information were recorded. Cases were compared with a reference group (normal oGCT with neither abnormal third-trimester growth nor polyhydramnios). Results A total of 282 pregnancies were in the study group, and 663 were in the reference group. Deliveries in the study group were at a higher risk for birth weight (BW)% > 90%, standard deviation, and postpartum hemorrhage when compared with the reference group (adjusted odds ratio: 2.3–5.6). Pregnancies complicated by both polyhydramnios and accelerated fetal growth were significantly more likely result in a BW% > 90% (odds ratio [OR]: 18.5; 95% confidence interval [CI]: 8.9–38.6) and PPH (OR: 4.2; 95% CI: 2.4–7.6). Conclusion Pregnancies with normal oGCT that develop polyhydramnios and accelerated growth are at higher risk for maternal and neonatal complications. Isolated polyhydramnios without accelerated growth increases the risk for delivery complications but not neonatal morbidity.

No abstract

Prenatal identification of the neonates at risk for hypoglycemia and other consequences of maternal diabetes is still a dilemma. Neonatal hypoglycemia is related to poor maternal glucose control in the 3 rd trimester (T3). The most common fetal ultrasound finding linked to poor maternal glucose control are polyhydramnios (POLY) and /or increased fetal abdominal circumference (AC>95). We tested the hypothesis that these altered T3 ultrasound findings can predict neonatal hypoglycemia. STUDY DESIGN: Singleton, non-anomalous pregnancies at risk for altered glucose metabolism were divided into 3 groups. Group 1: Intermediate glucose metabolism (IGM: an abnormal GCT (> 135 mg/dl) followed by a normal 3 hour testing), Group 2: Gestational Diabetes (GDM), and Group 3. Pre-gestational Diabetics (pGD). Cases with POLY (amniotic fluid index >24cm or maximum vertical pocket >8cm) and/or AC>95 were identified. Third trimester ultrasound, complete delivery information and neonatal blood sugar levels were recorded. Neonatal hypoglycemia was defined as < 40 mg/dl. The predictive value of POLY, AC>95 and POLY+AC>95 were compared with reference cohort (proven non-diabetic, without POLY and AC>95) using chisquare and regression analysis. RESULTS: Of 247 cases, 56(22.6%) were IGM, 95(38.4%) were GDM, and 96(38.8%) were pGD. The incidence of hypoglycemia was 8 (14.2%), 22 (23.1%), and 27(28.1%) respectively, which was statistically higher than the reference population incidence of 6.6% for all groups. The risk of neonatal hypoglycemia was increased in GDM and pGD if AC was >95 th percentile (OR 4.40; 95% CI 1.3-14.4 and 3.7; 95% CI 1.2-11.6 respectively). Presence of POLY only or POL-Y+AC>95 did not predict neonatal hypoglycemia in any of the groups (p>0.05, OR 0.8-1.2; 0.4-3.6). CONCLUSION: An AC>95 in T3 is a risk factor for neonatal hypoglycemia in GDM and pDM. It is not a risk factor for IGM. This information will be helpful in antepartum counselling and advising neonatal teams about monitoring and provision for care of hypoglycemia.

INTRODUCTION: To investigate the risk of impaired glucose metabolism (IGM) and ultrasound findings consistent with hyperglycemia on maternal and neonatal outcomes. METHODS: Retrospective case-control study of singleton, non-anomalous fetuses with IGM and gestational diabetes (GDM). IGM was defined as a one hour GST of greater than 134 but less than 2 abnormal values on 3 hour GTT. Ultrasound evidence of hyperglycemia was defined as abdominal circumference greater than 95th percentile and/or polyhydramnios. Individuals with IGM were divided into those with ultrasound evidence of hyperglycemia (IGM-US) and those without (IGM). Maternal demographics, delivery (gestational age (GA) at delivery, delivery mode, shoulder dystocia, lacerations), postpartum hemorrhage (PPH), and neonatal outcome (birth weight percentile (BW%), NICU admission, hypoglycemia, respiratory complications, glucose, and length of stay) were recorded. Composite morbidity was tabulated. Delivery and neonatal outcome variables were compared in individuals with IGM-US, IGM, and GDM. Odds ratios were calculated and adjusted with maternal age, race and gestational age at delivery. RESULTS: A total of 324 individuals with an abnormal 1-hour were included (96 with IGM-US, 108 with IGM, and 120 with GDM). In comparison to the IGM group, IGM-US had higher rates of induction, cesarean delivery, BW% > 90th percentile at delivery, and respiratory complications in the neonate (p less than 0.05 for all). Individuals with IGM-US had significantly larger neonates by birth weight and percentile than individuals with GDM (67.04[3.9-99.9 v 59.9[1.7-99.9](p = 0.001). The remaining outcomes were similar. CONCLUSION: Women with IGM and ultrasound markers of hyperglycemia should be identified and managed as a gestational diabetic.