Titre du document / Document title

Can glucose tolerance test predict fetal hyperinsulinism?

Auteur(s) / Author(s)

WEISS Peter A. M. ⁽¹⁾ ; HAEUSLER Martin ⁽¹⁾ ; TAMUSSINO Karl ⁽¹⁾ ; HAAS Josef ⁽¹⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Department of Obstetrics and Gynaecology, University of Graz, AUTRICHE

Résumé / Abstract

Objective To establish cut off levels for oral glucose tolerance test in pregnancy using fetal hyperinsulinism as a clinical endpoint. Design Capillary blood glucose levels at 0, 1, and 2 hours after the ingestion of either 1 g/kg or 75 g glucose, at 28 (SD 5) weeks of gestation were analysed in 220 women with elevated amniotic fluid insulin levels [≥ 42 pmol/L (≥ 7 pU/mL)] after a mean (SD) of 31 weeks (3) and in 220 nondiabetic controls. Results In women with elevated amniotic fluid insulin levels the mean (SD) capillary blood glucose values at 0, 1, and 2 hours were 5.2 mmol/L (1.0) [94 mg/dL (18)]. 10.5 mmol/L (1.4) [189 mg/dL (25)] and 8.2 mmol/L (2.0) [147 mg/dL (36)], respectively. The one-hour value had the highest sensitivity to predict elevated amniotic fluid insulin levels. The 5th centile of the one-hour blood glucose levels representing a detection rate of 95% was 8.9 mmol/L (160 mg/dL). Conclusion Glucose cut off levels in most established oral glucose tolerance test criteria are too high, to accurately predict amniotic fluid hyperinsulinism. A one-hour test may be sufficient for detecting amniotic fluid hyperinsulinism. Since different loads (1 g/kg, 75 g or 100 g) and blood fractions (venous plasma or capillary blood) have minimal impact on oral glucose tolerance test results, a single one-hour cut off of 8.9 mmol/L (160 mg/dL), independent of the sampling method, may be appropriate for the diagnosis of gestational diabetes mellitus severe enough to cause amniotic fluid hyperinsulinism.

Revue / Journal Title

BJOG   ISSN 1470-0328 

Source / Source

2000, vol. 107, n^o12, pp. 1480-1485 (30 ref.)

Langue / Language

Anglais

Editeur / Publisher

Blackwell, Oxford, ROYAUME-UNI  (2000) (Revue)

Mots-clés anglais / English Keywords

Glucose tolerance test ; Glucose ; Capillary blood ; Insulin ; Hyperinsulinemia ; Oral administration ; Pregnancy ; Amniotic fluid ; Diabetes mellitus ; Mother ; Predictive value ; Diagnosis ; Prenatal ; Human ; Fetus ; Female ; Pancreatic hormone ; Protein hormone ; Endocrinopathy ; Pregnancy disorders ;

Mots-clés français / French Keywords

Hyperglycémie provoquée ; Glucose ; Sang capillaire ; Insuline ; Hyperinsulinémie ; Voie orale ; Gestation ; Liquide amniotique ; Diabète ; Mère ; Valeur prédictive ; Diagnostic ; Prénatal ; Homme ; Foetus ; Femelle ; Hormone pancréatique ; Hormone protéine ; Endocrinopathie ; Gestation pathologie ;

Mots-clés espagnols / Spanish Keywords

Hiperglicemia provocada ; Glucosa ; Sangre capilar ; Insulina ; Hiperinsulinemia ; Vía oral ; Gestación ; Líquido amniótico ; Diabetes ; Madre ; Valor predictivo ; Diagnóstico ; Prenatal ; Hombre ; Feto ; Hembra ; Hormona pancreática ; Hormona proteina ; Endocrinopatía ; Gestación patología ;

Localisation / Location

INIST-CNRS, Cote INIST : 1086, 35400009401796.0050