Elsevier

Obstetrics & Gynecology

Volume 102, Issue 4, October 2003, Pages 850-856
Obstetrics & Gynecology

Original research
Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth

https://doi.org/10.1016/S0029-7844(03)00661-6Get rights and content

Abstract

Objective

To investigate whether different degrees of maternal glucose intolerance are associated with the risk of spontaneous preterm birth.

Methods

We performed a cohort study of 46,230 pregnancies screened by a 50-g, 1-hour oral glucose tolerance test between 24 and 28 gestation weeks at the Northern California Kaiser Permanente Medical Care Program. Spontaneous preterm birth was defined as an infant born at less than 37 gestation weeks with at least one of the following: spontaneous labor, preterm premature rupture of membranes, or incompetent cervix. Glucose tolerance status was categorized as normal screening (1-hour plasma glucose less than 140 mg/dL), abnormal screening (1-hour plasma glucose of at least 140 mg/dL with a normal diagnostic 100-g, 3-hour oral glucose tolerance test result), Carpenter–Coustan (plasma glucose measurements during the diagnostic oral glucose tolerance test met the thresholds but were lower than the National Diabetes Data Group thresholds), and gestational diabetes mellitus (GDM) by the National Diabetes Data Group criteria.

Results

One thousand nine hundred fifty-six spontaneous preterm births occurred. Age-adjusted incidences of spontaneous preterm birth were 4.0% in normal screening, 5.0% in abnormal screening, 6.7% in Carpenter–Coustan, and 6.7% in GDM. In a logistic regression model adjusted for age, race–ethnicity, preeclampsia–eclampsia–pregnancy-induced hypertension, chronic hypertension, polyhydramnios, and birth weight for gestational age, pregnancies with abnormal screening, Carpenter–Coustan, and GDM had a significantly higher risk of spontaneous preterm birth than pregnancies with normal screening (relative risk [95% confidence interval]: 1.23 [1.08, 1.41], 1.53 [1.16, 2.03], and 1.42 [1.15-1.77], respectively).

Conclusion

The risk of spontaneous preterm birth increased with increasing levels of pregnancy glycemia. This association was independent of perinatal complications that could have triggered early delivery.

Section snippets

Materials and methods

The setting of the study was the Kaiser Permanente Medical Care Program of Northern California, a large group-practice prepaid health plan that has approximately 2.7 million members in a 14-county region in Northern California. The Kaiser Permanente Medical Care Program of Northern California membership represents approximately 30% of the surrounding population and is representative of the population living in the same geographic area demographically, ethnically, and socioeconomically, except

Results

Among the 46,230 pregnancies that underwent a 50-g, 1-hour oral glucose tolerance test at 24–28 weeks and resulted in deliveries at the Kaiser Permanente Medical Care Program of Northern California between January 1996 and June 1998, the mean age of the women was 28.7 years (standard deviation [SD] 5.9). The race–ethnicity distribution was 50.8% white, 16.6% Asian, 20.0% Hispanic, 7.4% black, and 5.3% other or unknown. Among these pregnancies, 1956 (4.2%) spontaneous preterm births occurred.

Discussion

We found that GDM and lesser degrees of maternal hyperglycemia (such as abnormal screening or the lower Carpenter–Coustan plasma glucose thresholds in pregnancies without GDM) were associated with an increased risk of spontaneous preterm birth. These associations were also independent of conditions such as preeclampsia–eclampsia and birth weight for gestational age, which may have triggered an earlier delivery.

Our results are consistent with the results of a study5 including a small number (n =

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Supported by a grant (R01 DK 54834) from the National Institute of Diabetes and Digestive and Kidney Diseases, a Research Award from the American Diabetes Association, and a research award from Kaiser Foundation Research Institute given to AF.

Two abstracts on portions of these data were published in the abstract book of the 59th Annual Scientific Sessions of the American Diabetes Association (Diabetes 2002;51 Suppl 2) and in the abstract book of the 2001 Congress of Epidemiology (Am J Epidemiol 2001;153 Suppl).

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