Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: comparison with normal and gestational diabetic patients.

OBJECTIVE: The purpose of this study was to evaluate the characteristics and outcomes of patients who had abnormal glucose challenge test results and subsequent normal oral glucose tolerance test results and to assess whether such patients are at a greater risk than normal pregnant patients for adverse perinatal outcome. STUDY DESIGN: In this retrospective cohort study that was conducted between June and December 2003, 101 pregnant women (group A) had an abnormal glucose challenge test result and a normal oral glucose tolerance test result. Data were also collected on 2 control groups: 100 pregnant women with normal glucose challenge test results (group B) and all 76 pregnant women who were diagnosed with gestational diabetes mellitus during this period of time (group C). Patients with multiple pregnancies, chronic hypertension, pregestational diabetes mellitus, or any other maternal or fetal problems that were diagnosed before 24 weeks (when the glucose challenge test was performed) were excluded from the study groups. The following data were collected and analyzed: maternal age, maternal weight and height, parity and gravidity, diabetes mellitus in first-degree relatives, medical and obstetric history, ethnicity, complications during the third trimester of pregnancy, birth weight, gestational age at delivery, mode of delivery, Apgar scores, cord blood gas results, maternal complications of labor and during the postpartum period, and infant admission to the neonatal intensive care unit. For comparison between groups, we used the Student t test, 1-way analysis of variance, the chi-square test, and stepwise logistic regression. RESULTS: Patients in groups A and C were significantly older compared with group B (29.2 +/- 5.6 years and 30.4 +/- 5.5 years, respectively, vs 24.8 +/- 5.5 years; P < .01), had a lesser rate of primiparity (48% and 31%, respectively, vs 24%; P < .05), had greater body mass index (30.8 +/- 5 kg/m2 and 31.3 +/- 6 kg/m2, respectively, vs 29.2 +/- 4.4 kg/m2; P < .01), had a greater rate of previous gestational diabetes mellitus (6% and 20%, respectively, vs 0%; P < .05), and had a greater rate of first-degree family members with diabetes mellitus (21% and 21%, respectively, vs 3%; P < .01). None of the outcome parameters was statistically significant when group A was compared with group B. CONCLUSION: Patients with an abnormal glucose challenge test result and a subsequent normal oral glucose tolerance test result have different maternal characteristics and backgrounds compared with patients in whom both test results are normal, yet both groups have normal outcomes. We should continue to consider patients who have an abnormal glucose challenge test result and subsequent normal oral glucose tolerance test result as low-risk; however, these findings may represent an indication of an increased likelihood for the development of overt diabetes mellitus later in life.

Histologic and colposcopic correlates of ASCUS pap smears in pregnancy.

OBJECTIVE: A historic cohort analysis was performed to assess the colposcopic and histologic correlates of atypical squamous cells of undetermined significance (ASCUS) Pap smears in pregnant and nonpregnant women. MATERIALS AND METHODS: A chart review of all gynecologic and obstetric patients seen in the outpatient clinic at the Maimonides Medical Center between January 1996 and December 1999 was undertaken. All of the charts of patients with ASCUS Pap smears were reviewed to confirm the diagnosis and to obtain medical and demographic information. To be eligible for inclusion, patients needed to have a documented colposcopic exam within 6 months of the ASCUS Pap smear and be between the ages of 14 and 45 years old. The records from the colposcopic examination including histologic data were subsequently reviewed. The generalized Fisher exact test was utilized to determine the exact probability. RESULTS: Over a 4-year period from January of 1996 to December of 1999, 198 women were diagnosed with ASCUS on their Pap smears. A total of 122 patients met the inclusion criteria. Of those included in the study, 58 were pregnant at the time of diagnosis and 64 were nonpregnant. The mean age of the obstetric and gynecologic patients was 26.9 (range = 18-37) and 31.0 (range = 18-44) years, respectively (p = NS). Thirty-two (50%) nonpregnant patients had histologic findings of cervical intraepithelial neoplasia (CIN) compared with 15 of the 45 (33.3%) (p = .019) obstetric patients who had biopsies within the first 6 months postpartum. CIN 1 was detected in 12 of the 45 (26.7%) biopsies of the postpartum patients and 26 of the 64 (40.6%) (p = .16) gynecologic patients. CIN 2,3 was found in 2 of the 45 (4.4%) postpartum patients versus 6 of the 64 (9.4%) (p = .12) gynecologic patients. One pregnant woman with ASCUS was found to have cervical cancer (2.2%). Overall, a biopsy proven neoplastic lesion was found in 15 of 45 (33.3%) postpartum women compared with 32 of the 64 (50%) (p = .019) nonpregnant women. CONCLUSION: A cytologic diagnosis of ASCUS in pregnancy is associated with a significantly lower rate of neoplasia than the rate of neoplasia found among nonpregnant women with an ASCUS smear. A risk of cervical cancer following an ASCUS Pap smear was 2.2% in our pregnant population. Therefore, ASCUS diagnosed on the Pap smear in both pregnant and nonpregnant women warrants colposcopy and close follow-up.