One Abnormal Value on the 3-hour Oral Glucose Tolerance Test in Pregnancy Is Associated with Future Type 2 Diabetes Risk Gestational diabetes mellitus Gestational diabetes mellitus (GDM) is associated with an increased risk of developing type 2 diabetes (T2D). A third to half of women with a history of GDM develop T2D within 3-5 years and 70% develop T2D after 10 years. We hypothesized that women who did not meet the Carpenter/Coustan criteria for GDM because they had only one
abnormal value on the 100-g 3-hour oral glucose tolerance test (OGTT) were at increased risk of developing T2D. To address this hypothesis, we performed a cohort study of women who delivered between 1985 and 2002 at Group Health in Washington state. Eligible women (N=6,237; age 32.1[plusmn]5.7 years, mean[plusmn]SD) were enrolled [ge]1 year before delivery and received subsequent care at Group Health. T2D was ascertained through 2005 based on ICD-9 codes, pharmacy data for insulin or oral
agents, or fasting glucose [ge]126 and/or nonfasting glucose [ge]200 mg/dl on two occasions. During pregnancy, 3,671 women had a normal OGTT; 1,252 had one abnormal value; and 1,313 had GDM ([ge]2 abnormal values based on the Carpenter/Coustan criteria: fasting glucose [ge]95, 1-hour [ge]180, 2-hour [ge]155, 3-hour [ge]140 mg/dl). Subsequent T2D was diagnosed in 49 women (1.3%) with a normal OGTT, 31 (2.5%) with one abnormal value, and 67 (5.1%) with GDM. The median follow-up duration was 7
(interquartile range 3.5-11.8) years. Women with one abnormal result were at increased risk of developing T2D compared to those with normal values (hazard ratio, HR, 2.20, 95%CI 1.41-3.45; P=0.001) adjusting for age and multiparity. Of the women with one abnormal value, 227 (18.1%) had an abnormal fasting, 362 (29.0%) had an abnormal 1-hour, 460 (36.7%) had an abnormal 2-hour, and 203 (16.2%) had an abnormal 3-hour glucose. T2D developed in 6.1% of those with an isolated abnormal fasting, 1.9%
with an abnormal 1-hour, 1.7% with an abnormal 2-hour, and 1% with an abnormal 3-hour glucose. T2D among these women with one abnormal value was significantly associated with an abnormal fasting (HR 5.83, 95%CI 3.25-10.46; P[lt]0.001), but not with an abnormal 1-hour (HR 1.70, 95%CI 0.76-3.76; P=0.2), 2-hour (HR 1.80, 95%CI 0.91-3.57; P=0.09) or 3-hour glucose (HR 0.38, 95%CI 0.05-2.76; P=0.3) adjusting for age and multiparity. While having one abnormal OGTT value does not meet criteria for GDM,
the risk of developing T2D is elevated in these women. Therefore, women with a single abnormal OGTT value during pregnancy, particularly a fasting value, should be considered for surveillance for the future development of T2D. DARCY B. CARR, KATHERINE M. NEWTON, KRISTINA M. UTZSCHNEIDER, JENNY TONG, FERNANDO GERCHMAN, STEVEN E. KAHN, SUSAN R. HECKBERT, Seattle, WA 0995-P Epidemiology Congress: 67th Scientific Sessions (2007) Why do I need a glucose screening test during pregnancy?Most healthcare providers routinely recommend a glucose screening test (also called a one-hour glucose challenge test, or GCT) to check for gestational diabetes. Gestational diabetes is a high blood sugar (glucose) condition that some women get during pregnancy. Between 2 and 10 percent of expectant mothers develop this condition, making it one of the most common health problems during pregnancy. And because the condition rarely causes any symptoms, testing is the only way to find out whether you have it. The GCT is a screening test, which means it won't give you a diagnosis. Instead, it's designed to identify as many women as possible who might have gestational diabetes but need more testing to find out. So a positive result doesn't mean that you have gestational diabetes. In fact, only about a third of women who test positive on the glucose screening test actually have the condition. If you test positive, you'll need to take the glucose tolerance test (GTT) – a longer, more definitive test that tells you for sure whether you have gestational diabetes. Some providers skip the glucose screening test altogether and instead order a shortened version of the glucose tolerance test, which is also called a one-step test (see below). When is the glucose screening test taken during pregnancy?You typically get a glucose screening test between 24 and 28 weeks of pregnancy. However, your provider may want you to be screened earlier than 24 weeks if a routine urine test shows a high level of sugar in your urine or if you're considered high risk. If the results are normal, you'll be screened again at 24 to 28 weeks. Of course, if you were diagnosed with diabetes before pregnancy, you won't need to be screened. Instead, you'll continue to work with your provider to manage your condition during pregnancy. How is the glucose screening test done? Do I have to fast?No, you don't have to fast for the screening test. You can eat and drink that day as you normally would. Here's what to expect during and after the test:
I have the results of my glucose screening test. What's the normal range for blood sugar?Different providers use different standards for determining whether your level is too high. Some will say that if your one-hour blood sugar level is 140 milligrams of glucose per deciliter of blood plasma (mg/dL) or more, you need to have the glucose tolerance test. Others put the cutoff at 130 mg/dL to catch more women who may have gestational diabetes, even though there are likely to be more false positives this way. If your blood glucose level for this screening is higher than 200 mg/dL, most providers will consider you diabetic and you won't be required to take the glucose tolerance test. But any score between 140 and 200 means that you'll have to take the three-hour glucose tolerance test for a definite diagnosis. What is the glucose tolerance test?The glucose tolerance test (GTT) is also called the oral glucose tolerance test (OGTT) or the three-hour glucose test. The GTT determines for sure whether you have gestational diabetes. Usually, you'll be asked to take this test if you've received a positive result on the glucose screening test. In many ways, the GTT is similar to the screening test, but it takes longer and requires multiple blood draws. What is the glucose tolerance test like? Do I have to fast?Fast overnight: Typically you're instructed to eat a late meal the night before the test and then to eat or drink nothing after that, except for sips of water. The fasting period is usually 8 to 14 hours before the test, so you'll want to schedule the test for first thing in the morning. Here's what to expect at the lab:
Some tips to make your test more comfortable:
Results: After the test, if one of the readings is abnormal, you may have to take another test later in your pregnancy. Or your provider may ask you to make some changes in your diet and exercise routine. See "What is the treatment for gestational diabetes?" below. If two or more of your readings are abnormal, you'll be diagnosed with gestational diabetes. Your provider will talk to you about a treatment plan. I have the results of my glucose tolerance test. What's the normal range, and what's considered a high blood sugar level?This chart shows the levels that the American Diabetes Association considers abnormal at each interval of the three-hour glucose tolerance test:
What is the two-hour glucose tolerance test, or one-step test? Do I have to fast?The two-hour glucose tolerance test is basically a shortened version of the three-hour tolerance test. If you get this test, you likely won't do the screening test first, which is why the two-hour version is sometimes referred to as the "one-step" glucose tolerance test. Overnight fast: Typically you're instructed to eat a late meal the night before the test and then to eat or drink nothing after that, except for sips of water. The fasting period is usually 8 to 14 hours before the test, so you'll want to schedule the test for first thing in the morning. Here's what to expect at the lab:
This chart shows the levels that the American Diabetes Association considers abnormal at each interval of the two-hour glucose tolerance test (you'll notice these differ only slightly from the three-hour glucose tolerance test):
You're slightly more likely to get a gestational diabetes diagnosis with the two-hour test than with the three-hour test because the diagnosis criteria are a little different. The American College of Obstetricians and Gynecologists (ACOG) favors the more traditional two-step approach: glucose screening followed by a three-hour tolerance test if the screening is positive. However, a small number of providers use the one-step test. Will the glucose tests make me feel sick?Some moms-to-be feel nauseated after drinking the glucose solution, and a few even throw up. It may help to eat something a few hours before the screening test. If you vomit soon after you've gotten the drink down, you'll have to come back on another day and repeat the test. It's actually more common for women to feel sick during the three-hour glucose tolerance test, because the solution for that test is twice as sweet or contains twice as much liquid as the one for the screening test, and you have to drink it after fasting. Does glucose testing carry any risks?Glucose testing and screening is very low risk. As with any blood draw, there is a slight risk of:
Is there anything I can do to help me pass the glucose tests?No. If you have gestational diabetes, the glucose tolerance test will detect it. However, there are steps you can take to reduce your chances of developing gestational diabetes, as well as to keep your blood glucose levels stable even if you do have the condition. These are:
Can I skip taking glucose tests?Yes, you can decline a glucose screening or test, but opting out is not recommended. Since most women with gestational diabetes don't have any symptoms, getting tested may be the only way to find out if you have the condition. Gestational diabetes puts you and your baby at risk of complications. Detecting gestational diabetes allows you to work with your provider on managing and reducing those risks so you can enjoy a healthy pregnancy. What is the treatment for gestational diabetes?If you fail the glucose tolerance test and are diagnosed with gestational diabetes, you'll work with your provider or a diabetes specialist, and possibly a nutritionist. Together you'll come up with a treatment plan, which will cover:
Your high blood sugar should last only as long as your pregnancy. But some women who develop diabetes during pregnancy still have it after delivery, so you'll have another glucose test six to eight weeks after your baby is born. Learn more Folic acid may reduce gestational diabetes risk How will gestational diabetes affect my baby? Tips from moms-to-be with gestational diabetes Will gestational diabetes affect my birth options? What is considered an abnormal 3 hour glucose test?What Abnormal Results Mean. Abnormal blood values for a 3-hour 100-gram oral glucose tolerance test are: Fasting: greater than 95 mg/dL (5.3 mmol/L) 1 hour: greater than 180 mg/dL (10.0 mmol/L)
What does it mean when your glucose test comes back abnormal?If you had a fasting blood glucose test: A level of 100 to 125 mg/dL (5.6 to 6.9 mmol/L) means you have impaired fasting glucose, a type of prediabetes. This increases your risk of developing type 2 diabetes. A level of 126 mg/dL (7 mmol/L) or higher usually means you have diabetes.
What is considered an abnormal glucose level?A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes.
What is the normal range for 3 hour glucose test during pregnancy?Talk to your health care provider if you have any questions about this document, your condition or your treatment plan. 2 hours after drinking the glucose drink, a normal blood sugar is less than 155 mg/dL. 3 hours after drinking the glucose drink, a normal blood sugar is less than 140 mg/dL.
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