Pregnant women with impaired tolerance to an oral glucose load in the afternoon: Evidence suggesting that they behave metabolically as patients with gestational diabetes

Objective: In previous studies we observed the existence of a circadian variation of the blood glucose response to oral glucose in pregnant women with higher values at 4 pm. Some women with increased risk of diabetes with normal oral glucose tolerance tests at 8 am also had values above maximum normal levels at 4 pm. The aim of this trial was to determine the clinical significance of this impaired tolerance in the afternoon. Study Design: Seventy-seven pregnant women with normal risk of diabetes (65 of normal weight and 12 overweight), 75 with increased risk of diabetes (26 overweight), and 12 patients with gestational diabetes were incorporated in the study. All women underwent two oral glucose tolerance tests (1.5 gm/kg) at 31 to 32 weeksʹ gestation at 8 am and 4 pm with a 1-week interval. At 33 weeksʹ gestation a whole-day blood glucose profile was performed with usual food intake; samples were withdrawn before each meal and at 30, 60, and 120 minutes after each meal. The weight of the newborns was recorded. Results: (1) Results of oral glucose tolerance tests confirmed a circadian variation of the response in all groups; (2) 37 women with increased risk of diabetes had higher values after oral glucose tolerance testing than the normal threshold at 4 pm but not at 8 am; (3) among women with normal risk of diabetes all values were within the normal range despite the circadian variation; (4) blood glucose levels during whole-day profiles were normal in women with normal risk of diabetes and with increased risk of diabetes with normal oral glucose tolerance testing at 4 pm, whereas all women with increased risk of diabetes and impaired tolerance in the afternoon showed hyperglycemic episodes; (5) the percentage of newborns with high weight (>90th percentile) among women with increased risk of diabetes and abnormal oral glucose tolerance tests at 4 pm was similar to the percentage found in women with gestational diabetes and much higher than the one observed in women with normal oral glucose tolerance tests in the afternoon. Conclusions: The impairment of the response to oral glucose tolerance testing seen in some patients with increased risk of diabetes at 4 pm but not at 8 am seems of clinical significance in view of the abnormal whole-day blood glucose profile these women had and the weights of the newborns. (Am J Obstet Gynecol 1998;178:1059-66.)