IMPACT OF INCREASING CARBOHYDRATE INTOLERANCE ON MATERNAL-FETAL OUTCOMES IN 3637 WOMEN WITHOUT GESTATIONAL DIABETES - THE TORONTO TRI-HOSPITAL GESTATIONAL DIABETES PROJECT

OBJECTIVE: Our purpose was to assess maternal-fetal outcomes in patien ts with increasing carbohydrate intolerance not meeting the current cr iteria for the diagnosis of gestational diabetes. STUDY DESIGN: We con ducted a prospective analytic cohort study in which nondiabetic women aged greater than or equal to 24 years, receiving prenatal care in thr ee Toronto teaching hospitals, were eligible for enrollment. A glucose challenge test and an oral glucose tolerance test were administered a t 26 and 28 weeks' gestation, respectively; risk factors for unfavorab le maternal-fetal outcomes were recorded. Caregivers and patients were blinded to glucose values except when test results met the current cr iteria for gestational diabetes. RESULTS: Of 4274 patients screened, 3 836 (90%) continued to the diagnostic oral glucose tolerance test. The study cohort was formed by the 3637 (95%) patients without gestationa l diabetes, carrying singleton fetuses. Increasing carbohydrate intole rance in women without overt gestational diabetes was associated with a significantly increased incidence of cesarean sections, preeclampsia , macrosomia, and need for phototherapy, as well as an increased lengt h of maternal and neonatal hospital stay. Multivariate analysis showed that increasing carbohydrate intolerance is an independent predictor for various unfavorable outcomes. CONCLUSION: Increasing maternal carb ohydrate intolerance in pregnant women without gestational diabetes is associated with a graded increase in adverse maternal-fetal outcomes.