Evaluation Of Intravenous Glucose Tolerance Test As Amethod Of Predication Of Intrauterine Growth Ret Ardation:

Rokia Ahmed Ahmed Abou State

The aim of this work is to evaluate maternal hypoglycaemiaas a causative factor of IUGR and the value of intravenous glucosetolerance test as a method of prediction of IUGR.One hundred two cases in the third trimester of pregnancy attendingKafr EI Shikh general hospital antenatal clinic were studied. Patientschoosen for the study had a high risk of developing IUGR. Cases includedin the study: 71 patients had a single risk factors for lUGR including:Preeclampsia (50 cases), Eclampsia (6),anaemia (9) and Cardiac disease (6).2) 31patients had multiple risk factor for IUGR including.Preeclampsia + anaemia (17), preeclampsia + cardiac d. (5). Preeclampsia+anaemia + cardiac disease (one case), Eclampsia + anaemia (5) andcardiac disease + anaemia (3 cases).:IV.GTT was performed.Fasting blood sugar and 10 minutes and 60 minutes blood glucoseafter IV. glucose injection was analized by using glucometer apperatus.Newly born infants’ weight was recorded and IUGR could be diagnosed(birth weight below the 10 percentile according to gestational age.assessment of anatomical features that indicates maturity in thenewly born was also performed.IUGR babies were compared to hypoglycaemia and statistical evaluationof the significance of hypoglycaemia as a cause of lUGR wasstudied in all cases.- 81 -- 82 -There was a significant correlation between maternal hypoglycaemiaand lUGR in the studied group. Also there was a tendency towardslowering blood sugar level I in growth retarded newly born infants.Fasting blood sugar level and at 10 minutes and 60 minutes afterIV. glucose load were silgnificantly lower in cases with IUGR thanin cases with no IUGR.In patients with a single risk factor for IUGR there was no statisticallysignificant difference between the number of lUGR in those withhypoglycaemic compared to those with normoglycaemic mothers(P> 0.05).In patients with multiple risk factors for IUGR, the number of IUGRinfants was statistically higher in hypoglycaemic patients .(P < 0.0001)In patients with pregnancy toxaemia only; there was no statisticaldifference between the number of IU.GR infants in hypoglycaemicIX normoglycaemic groups P <. 0.05. So hypoglycaemia was not afactor associated with the occurrane of IUGR in patients with pregnancytoxaemia only.In patients with pregnancy toxaemia associated with other risk factorthe number of IUGR infants was statistically more in hypoglycaemiacompared to normoglycaemic groups therefore hypoglycaemia wasa factor associated with the occurrance of IUGR.Anaemia appears to represent a significant cause in IUGR only ifassociated with other maternal diseases such as pregnancy toxaemiaand cardiac disease.In cardiac patients the number of IUGR was statistically more inthe hypoglycaemia group (P = 0.01), most probably due to associationwith other maternal diseases.- 83 -CONCLUSIONSWe agree with most workers that hypoglycaemia may bea causative factor in lUGR in patients with a high risk prelgnancyand IV.GTT is a good tool in predecting IUGR in these patients.Fasting blood glucose is a good negative test as it had afalse -ve result around 15%. However, if it is -ve (less than 60 rng/dl),it has a galse -ve result of 37%. Therefore, it needs to be bachedby the 10 minutes blood glucose level which had a false -ve resultaround 14% and so it increases the accurracy of fasting blood glucosetest by 23%.