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      The Relationship between Maternal Gestational Impaired Glucose Tolerance and Risk of Large-for-Gestational-Age Infant: A Meta-Analysis of 14 Studies

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          Abstract

          Objective:

          To explore, by conducting a meta-analysis, whether gestational impaired glucose tolerance (IGT) is an independent predictor of neonatal large for gestational age (LGA) or not.

          Methods:

          Medline, Embase, and Cochrane Library databases were searched to identify published epidemiological studies (cohort and case-control studies) investigating the association between gestational IGT and neonatal LGA. Calculations of pooled estimates were conducted in random-effect models or fixed-effects models. Heterogeneity was tested by using chi-square test and I2 statistics. Egger’s test (linear regression method) and Begg’s test (rank correlation method) were used to assess potential publication bias.

          Results:

          Fourteen observational studies were included in the meta-analysis. The overall risk for the effect of IGT on LGA was 2.09 (1.56, 2.78). Stratified analyses showed no differences regarding different geographic regions or the analysis of overall adjusted odds ratios. No evidence of publication bias was observed in either Egger’s test or Begg’s test results.

          Conclusion:

          Gestational IGT is an independent predictor of neonatal LGA.

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          Most cited references24

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          Clinical Outcomes of Pregnancies Complicated by Mild Gestational Diabetes Mellitus Differ by Combinations of Abnormal Oral Glucose Tolerance Test Values

          Mary Helen Black, David A. Sacks, Anny H Xiang … (2010)
          OBJECTIVE To examine the association between levels of hyperglycemia, determined by each prenatal oral glucose tolerance test (OGTT) value (fasting, 1 and 2 h), and maternal and perinatal outcomes and to determine whether the risk for these outcomes differs for women whose value(s) equaled or exceeded the thresholds for gestational diabetes mellitus (GDM) established by the International Association of Diabetes in Pregnancy Study Groups (IADPSG). RESEARCH DESIGN AND METHODS This article discusses a retrospective study of 8,711 women, delivering at ≥20 weeks' gestation, who had a prenatal 2-h 75-g OGTT without a prior 50-g challenge and were not treated with insulin, glyburide, diet, and/or exercise during pregnancy. Associations between adverse outcomes and elevated OGTT values are reported. RESULTS After excluding treated women, 19.4% of the remaining women had IADPSG-defined GDM. Continuous fasting, 1- and 2-h OGTT measures, and GDM (yes/no) were significantly associated with most adverse outcomes. However, the magnitude and significance of risk for these outcomes differed by various combinations of abnormal glucose values. Women with normal fasting and elevated postload values were at higher risk for preterm delivery, gestational hypertension, and having an infant with hyperbilirubinema, whereas women with elevated fasting and normal postload values were at higher risk of having a large-for-gestational-age infant, compared with women without GDM. CONCLUSIONS Risks for different adverse outcomes vary depending on which single or combined IADPSG-defined OGTT thresholds are equaled or exceeded. Prospective studies are needed to determine whether changing pre- and postprandial glucose targets during pregnancy will more uniformly reduce adverse outcomes.
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            Women with impaired glucose tolerance during pregnancy have significantly poor pregnancy outcomes.

            Xiao-Meng Zhang, Yanni Zhang, Cuiping Zhang … (2002)
            This article tests the hypothesis that women with impaired glucose tolerance (IGT) have the same pregnancy outcomes as those of their counterparts with normal glucose tolerance. From December 1998 to December 1999, 84 of 90 antenatal care base units (ACBUs) under the Tianjin Antenatal Care Network in China participated in the first screening program for gestational diabetes mellitus (GDM). A total of 9,471 pregnant women under the care of participating ACBUs were screened. Of the women screened, 154 were positive for IGT. Of the 154 women, 102 opted for conventional obstetric care. The comparison group was 302 women of normal glucose tolerance (NGT). The initial screening consisted of a 50-g 1-h glucose test, and was carried out at 26-30 gestational weeks. Women with a serum glucose > or =7.8 mmol/l were followed up with a 75-g 2-h oral glucose tolerance test. The World Health Organization's diagnostic criteria for GDM were used. Women with IGT were at increased risk for premature rupture of membranes (P-ROM) (odds ratio [OR] 10.07; 95% CI 2.90-34.93); preterm birth (6.42; 1.46-28.34); breech presentation (3.47; 1.11-10.84); and high birth weight (90th percentile or 4,000 g) (2.42; 1.07-5.46); adjusting for maternal age, pregravid BMI, hospital levels, and other confounding factors. The presence of IGT in pregnancy is predictive of poor pregnancy outcomes.
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              How to interpret meta-analysis models: fixed effect and random effects meta-analyses.

              Dimitris Mavridis, Adriani Nikolakopoulou, Georgia Salanti (2014)
              This section of the journal is aimed at providing the essential information readers should know about the topics that are addressed in the 'Statistics in practice' paper published in the same issue of the journal. This stand-alone section has to be seen as an articulated summary of the main notions clinicians have to know about some basic concepts in statistics, which may be useful for their evidence-based practice. After going through these notes, readers are encouraged to read the 'Statistics in practice' articles. Of course, we welcome any feedback from you (via email or Twitter) about this! The EBMH Editors Relative treatment effects studied in trials are typically measured using an effect size. The observed effect sizes are synthesised to obtain a summary treatment effect via meta-analysis.
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Res Pediatr Endocrinol
                Journal ID (iso-abbrev): J Clin Res Pediatr Endocrinol
                Journal ID (publisher-id): JCRPE
                Title: Journal of Clinical Research in Pediatric Endocrinology
                Publisher: Galenos Publishing
                ISSN (Print): 1308-5727
                ISSN (Electronic): 1308-5735
                Publication date (Print): September 2016
                Publication date (Electronic): 1 September 2016
                Volume: 8
                Issue: 3
                Pages: 264-269
                Affiliations
                [1 ] Anhui Medical University School of Public Health, Department of Nutrition and Food Hygiene, Anhui, China
                Author notes
                * Address for Correspondence: Anhui Medical University School of Public Health, Department of Nutrition and Food Hygiene, Anhui, China E-mail: li1964li@ 123456163.com
                Article
                Publisher ID: 1776
                DOI: 10.4274/jcrpe.2583
                PMC ID: 5096488
                PubMed ID: 27087160
                SO-VID: d9ab7dad-cee9-494a-8b5b-ef42c8853fb5
                Copyright © © Journal of Clinical Research in Pediatric Endocrinology, Published by Galenos Publishing.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 6 November 2015
                Date accepted : 1 February 2016
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Pediatrics
                Keywords: gestational impaired glucose tolerance,large for gestational age,meta-analysis
                Data availability:
                ScienceOpen disciplines: Pediatrics
                Keywords: gestational impaired glucose tolerance, large for gestational age, meta-analysis

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