GLUCOSE VALUE LOWER THAN 5 MMOL/L AFTER A GLUCOSE LOADING TEST IS ASSOCIATED WITH ADVERSE PREGNANCY OUTCOMES RELATED TO GESTATIONAL DIABETES: SYSTEMATIC REVIEW AND META ANALYSIS
2Elizabeth Garrett Anderson Wing, University College Hospital, London
Problem Statements
Gestational diabetes mellitus (GDM) is associated with abnormal fetal growth. We aim to investigate pregnancy outcomes of a low glucose value after a glucose load (reactive hypoglycaemia - RH) to determine if women with RH based on certain cutoff values (5 mmol/l) have similar adverse outcomes to women with gestational diabetes.
Methods
The search strategy was applied to 4 databases between 19 December 2022 and 15 January 2023: Medline, Embase, Web of science, and Maternity & infant care database. MeSH terms and keywords were combined. The outcomes of interest were GDM- and hyperglycemia-related adverse pregnancy outcomes including large for gestational age (LGA), macrosomia, small for gestational age (SGA), Intrauterine Growth Restriction (IUGR), low birth weight (LBW), caesarean delivery, NICU admission, neonatal hypoglycaemia, polyhydramnios, 5-min APGAR score < 7, and preterm delivery. Abstracts and papers were reviewed by two assessors for inclusion. Studies were included irrespective of the threshold used to define ‘hypoglycaemia’. Disagreements were resolved by the senior author. Risk of bias assessment was performed with the Robvis tool, adapted to the Newcastle Ottawa scale. Studies deemed at low risk of bias were extracted and analysed with the Review Manager software. Subgroup analysis was performed based on glucose < 5mmol/l as threshold.
Results
From 14,745 records, 40 studies were selected for full-text assessment. Twenty-eight studies reporting on 75,453 participants, including 14,607 women with low glucose values, fulfilled eligibility criteria. Pregnancies with reactive hypoglycaemia lower than 5 mmol/l had a higher risk of SGA (RR = 1.43, 95%CI = 1.16, 1.76) and polyhydramnios (RR = 1.84, 95%CI = 1.07-3.16) compared to women with normal glucose tolerance.
Conclusions
Women with glucose values lower than 5 mmol/l after a glucose load are at risk for polyhydramnios, typically related to pregnancy diabetes. Also, these women are more likely to develop SGA. A prospective study is needed.
