ONE HOUR VERSUS TWO HOUR POST PRANDIAL BLOOD GLUCOSE MEASUREMENT IN WOMEN WITH GESTATIONAL DIABETES MELLITUS;

WHICH ONE SHOULD WE CHOOSE? A.Seval OZGU-ERDINC, Cantekin ISKENDER, Dilek UYGUR, Aysegul OKSUZOGLU,

M.Ilkin YERAL, K.Doga SECKIN, Zeynep I. KALAYLIOGLU, A. Nuri DANISMAN Zekai Tahir Burak Women Health Care, Education and Research Hospital

ANKARA, TURKEY

Introduction The study aimed to compare the efficacy of 1 hour (PP1)

and 2 hour (PP2) postprandial blood glucose test for the prediction of obstetric complications in patients with GDM. Our primary objective was to investigate whether PP1 and PP2 measurements have a correlation with adverse perinatal outcomes and if so the degree of correlation of PP1 and PP2 measurements differed from each other.

Material and Methods This prospective study consisted of 259 women with GDM

who were followed up at Zekai Tahir Burak Women Health Care, Education and Research Hospital, Ankara, Turkey, between June 2010 and January 2013. During each antenatal visit serum HbA1c and fasting capillary glucose (FPG) as well as capillary glucose at postprandial 1-hour (PP1) and postprandial 2-hour (PP2) were analyzed. Patients were screened for delivery route and adverse perinatal outcomes such as preterm delivery, preeclampsia, polyhydramnios, fetal macrosomia, low 5-min Apgar score, neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, fetal mortality and malformations.

The patients were divided in two groups as diet and insulin therapy. There were 144 patients on insulin therapy and 115 patients on diet therapy. A total of 531 blood glucose measurements were obtained for different gestational weeks between 24-41 gestational weeks 1-8 calculations per patient. For association between each hour of glucose measurement and each primary outcome, the method developed by Li et al. for modeling cross sectional outcomes with longitudinal covariates is used.

Results Unadjusted analyses showed that, in the insulin group,

macrosomia was positively associated with the change in PP2 (P value=0.0008). In addition, in the insulin group, antenatal, intrapartum and neonatal complications were all positively associated with the change in Hb1Ac levels. In the diet group, the only association was present between neonatal complications and FPG (P value<0.0001).

But on adjusted analysis FPG, PP1 and PP2 measurements did not predict any antenatal, labor and neonatal complications. Only HbA1c were able to predict fetal macrosomia on insulin therapy when controlled for confounding factors (P value=0.0032).

Conclusion The findings of the study suggest that none of the four

parameters were able to predict GDM related perinatal complications. Moreover, postprandial 1 hour and postprandial 2 hour serum glucose measurements were not superior to each other in predicting fetal macrosomia or perinatal complications. Based on our findings it can be concluded that both methods may be suitable for follow up as there are no clear advantages of one measurement over the other.

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MULTIVARIATE ANALYSIS Insulin Diet

LONGIT COVAR P VALUE LONGIT COVAR P VALUE

Delivery

Route

FPG 0.748 FPG 0.895

PP1 0.431 PP1 0.991

PP2 0.114 PP2 0.559

HbA1C 0.158 HbA1C 0.244

Macrosomia FPG 0.349 FPG 0.674

PP1 0.752 PP1 0.895

PP2 0.681 PP2 0.827

HbA1C 0.0032 HbA1C 0.904

Intrapartum

Complications

FPG 0.611 FPG 0.053

PP1 0.973 PP1 0.841

PP2 0.698 PP2 0.279

HbA1C 0.419 HbA1C 0.685

Antenatal

Complications

FPG 0.613 FPG 0.593

PP1 0.958 PP1 0.798

PP2 0.466 PP2 0.514

HbA1C 0.569 HbA1C 0.184

Postnatal Complications FPG 0.515 FPG 0.946

PP1 0.948 PP1 0.973

PP2 0.306 PP2 0.931

HbA1C 0.976 HbA1C 0.898

Preterm

Delivery

FPG 0.648 FPG 0.666

PP1 0.951 PP1 0.092

PP2 0.993 PP2 0.533

HbA1C 0.981 HbA1C 0.386

NICU

need

FPG 0.190 FPG 0.884

PP1 0.673 PP1 0.949

PP2 0.986 PP2 0.989

HbA1C 0.442 HbA1C 0.483

Preeclampsia FPG 0.914 FPG 0.816

PP1 0.500 PP1 0.706

PP2 0.135 PP2 0.897

HbA1C 0.886 HbA1C 0.912

Polyhydramnios FPG 0.537 FPG 0.552

PP1 0.544 PP1 0.857

PP2 0.239 PP2 0.920

HbA1C 0.189 HbA1C 0.404