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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055002543 copy

Prediction of low birth weight with hypoglycemia in glucose tolerance test

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

Determine the value of the combination of fasting glucose less than the 10th percentile (FG < p10) during 75 gram oral glucose tolerance test (75g OGTT) with maternal characteristics to predict low birth weight (LBW) established by Intergrowth-21st tables.

METHODS:

Prospective cohort study of pregnant women who was underwent 75g OGTT between 24 and 28.6 weeks. The 10th percentile fasting glucose of the population was determined at 65 mg/dL and women with risk factors that could modify fetal weight, including those related to intrauterine growth restriction, were excluded. Two groups were formed: group FG < p10 and group with normal fasting glucose. The main finding was the diagnosis of LBW. The association between FG < p10, maternal characteristics and LBW was established by multivariate logistic regression. The predictive performance of the models constructed was evaluated by receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis.

RESULTS:

349 women were eligible for study, of whom 66 (18.91%) had FG < p10; neonates in this group had lower birth weights (2947.28 g and 3138.26 g, p = 0.001), higher frequencies of LBW (25% and 6.81%, p < 0.001) and of weights < 2500 g in term births (8.6% and 2.3%, p = 0.034). The basal prediction model consisted of nulliparity by achieving an AUC of 60%, while the addition of FG < p10 resulted in the significant improvement of the previous model (AUC 72%, DeLong: p = 0.005).

CONCLUSIONS:

In pregnant women without factors that could modify fetal weight, the predictive model created by combining FG < p10 during 75g OGTT with nulliparity was significantly associated with increased risk of LBW.

REGISTRATION:

ClinicalTrials.gov: NCT04144595.

DESCRIPTORS
Hypoglycemia; Glucose Tolerance Test; Infant, Low Birth Weight; Longitudinal Studies

Characteristics	Fasting glucose		p
Characteristics	< percentile 10 (n = 60)	≥ percentile 10 (n = 279)	p
Age (years)	26 (20–31)	23 (20–28)	0.127^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
< 19	8 (13.33)	52 (18.63)	0.329^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
≥ 35	5 (8.33)	22 (7.89)	0.907^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
BMI during 75g OGTT (Kg/m2)	26.9 (23.6–29.8)	26.1(22.5–29.8)	0.394^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
Underweight	0	4 (1.43)	1^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Obese	15 (25)	66 (23.66)	0.825^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Gestational weight gain (kg)	10 (8–12)	9 (7–12)	0.367^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
Low weight gain	18 (30)	114 (40.86)	0.118^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Excessive weight gain	17 (28.33)	68 (24.37)	0.521^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Parity	2 (1–3)	1(1–3)	0.824^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
Nulliparity	28 (46.67)	141(50.53)	0.587^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Gestational age during 75g OGTT	26.4 (25.5–27.6)	26.4 (25.2–27.6)	0.663^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
Anemia (< 11 g/dL)	16 (26.67)	79 (28.31)	0.796^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Fasting glucose (mg/dL)	60 (57–61.5)	80 (73–86)	< 0.001^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.

Characteristics	Fasting glucose		p
Characteristics	< percentile 10 (n = 60)	≥ percentile 10 (n = 279)	p
Age at birth (weeks)	39 (38.4–39.6)	39(38.1–40)	0.356^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
< 34	1 (1.67)	2 (0.72)	0.443^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
< 37	2 (3.33)	22 (7.88)	0.275^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
> 41	2 (3.33)	5 (1.79)	0.359^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Birth weight (gram)	2947.28 (2833.82–3060.75)	3138.26 (3091.9–3184.7)	0.001^c c Variables with parametric distribution presented as mean (95%CI) and compared with Student’s t test.
< 2,500	6 (10)	13 (4.66)	0.103^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
> 4,000	0	3 (1.07)	1^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Percentile of birth weight IG21	29.32 (9.93–54.61)	49.24 (28.5–70.1)	< 0.001^a a Variables with nonparametric distribution presented as median (interquartile range) and compared with the Mann-Whitney U test.
< 3	5 (8.33)	5 (1.79)	0.006^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
< 10	15 (25)	19 (6.81)	< 0.001^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
> 90	2 (3.33)	15 (5.38)	0.511^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Gender of neonate
Female	24 (40)	145 (52)	0.092^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Male	36 (60)	134 (48)	0.092^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.
Apgar < 7 at 5 minutes	5(8.33)	16 (5.7)	0.449^b b Frequencies presented as n (%) and compared with Pearson’s X2 or Fisher’s exact test.

Model	OR	95%CI	p	AUC	95%CI	Sen (%)	Spe (%)	PPV (%)	NPV (%)
Maternal characteristics: Nulliparity	2.28	1.07–4.83	0.032	0.60	0.55–0.65	67.61	52.15	13.63	93.52
FG < 10th percentile	4.56	2.16–9.63	< 0.001	0.65	0.59–0.70	44.13	85.29	25	93.21
Nulliparity + FG < percentile 10	2.52 4.91	1.16–5.49 2.29–10.52	0.022 < 0.001	0.72	0.67–0.77^a a Comparison of AUC with previous model, DeLong: p = 0.005.	23.53	93.44	28.67	91.61

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