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False-Positive 1-Hour Glucose Challenge Test and Adverse Perinatal Outcomes

From the Center for Clinical Epidemiology and Biostatistics and Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and the Department of Obstetrics and Gynecology, Landstuhl Regional Army Medical Center, Landstuhl, Germany.

Address reprint requests to: David M. Stamilio, MD, University of Pennsylvania Medical Center, Division of Maternal Fetal Medicine, 2000 Courtyard Building, 3400 Spruce Street, Philadelphia, PA 19104; e-mail: dstamilio{at}obgyn.upenn.edu.

OBJECTIVE: To determine whether a false-positive 1-hour glucose challenge test (GCT) is associated with perinatal complications.

METHODS: We performed a retrospective cohort study of 1825 eligible pregnant women among a cohort of 1998 patients. Patients were screened for gestational diabetes mellitus (GDM) with the 1-hour 50-g GCT at 24–28 gestational weeks. A false-positive GCT was defined as a result greater than or equal to 135 mg/dL followed by a normal 3-hour glucose tolerance test (GTT). We compared the negative GCT and false-positive GCT cohorts for a composite perinatal outcome variable that included fetal macrosomia, antenatal death, shoulder dystocia, chorioamnionitis, preeclampsia, intensive care nursery admission, and postpartum endometritis. Secondary outcomes included cesarean delivery and each component variable of the composite. Unadjusted, stratified, and multiple logistic regression analyses were used to investigate the association between a false-positive GCT and the development of perinatal complications.

RESULTS: We identified 164 patients with a false-positive GCT and 50 patients with GDM. The false-positive GCT cohort on average was older, of higher parity, had a higher body mass index, and more frequently had chronic hypertension, sickle cell trait, and elevated midtrimester human chorionic gonadotropin levels. The false-positive GCT cohort more frequently had adverse perinatal outcomes, including the composite perinatal outcome (odds ratio [OR] 5.96, 95% confidenceinterval[CI]1.47,24.16),macrosomiagreaterthan 4500 g (OR 3.66, 95% CI 1.30, 10.32), antenatal death (OR 4.61, 95% CI 0.77, 27.48), shoulder dystocia (OR 2.85, 95% CI 1.25, 6.51), endometritis (OR 2.18, 95% CI 1.03, 4.63), and cesarean delivery (OR 1.76, 95% CI 0.99, 3.14).

CONCLUSION: A false-positive GCT is an independent risk factor for adverse perinatal outcomes.

LEVEL OF EVIDENCE: II-2

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