{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T17:20:30Z","timestamp":1783185630141,"version":"3.54.6"},"reference-count":45,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>\n            Objective\u2003This study aimed to determine whether pregnant women who have \u201cflat\u201d oral glucose tolerance test (OGTT) curves in pregnancy are at increased risk of maternal or neonatal adverse outcomes.<\/jats:p><jats:p>\n            Study Design\u2003We conducted a retrospective cohort study of the perinatal outcomes of pregnant women whose 100-g OGTT curve was \u201cflat,\u201d defined by a fasting serum glucose level below 95\u2009mg\/dL and the remaining values below 100\u2009mg\/dL. We compared their perinatal outcomes to women whose OGTT curve was \u201cnormal.\u201d The primary outcomes compared were the prevalence of macrosomic and small for gestational age (SGA) neonates. Secondary outcomes included hypertensive disorders of pregnancy (HDP), prelabor anemia, thrombocytopenia, intrauterine fetal demise, placental abruption, indicated induction of labor, meconium-stained amniotic fluid, mode of delivery, postpartum hemorrhage, blood product transfusion, postpartum readmission, neonatal gender, gestational age at delivery, preterm birth, birth weight, low birth weight, umbilical artery pH\u2009&lt;\u20097.1, Apgar score &lt;7 at 5\u2009minutes, neonatal intensive care unit admission, neonatal respiratory and infectious morbidity, and hypoglycemia. Composite adverse maternal and neonatal outcomes were also evaluated.<\/jats:p><jats:p>\n            Results\u2003There were 1,060 patients in the study group and 10,591 patients in the control group. Patients with a flat OGTT were younger (28.3 vs. 29.8, p\u2009&lt;\u20090.001) and less likely to be over 35 years old (14.1 vs. 23.4%, p\u2009&lt;\u20090.001). They had a reduced risk of delivering a macrosomic neonate (11.4 vs. 15.1%, OR\u2009=\u20090.7 [0.58\u20130.89], p\u2009=\u20090.001) and having an unplanned cesarean delivery (7.5 vs. 10.2%, OR\u2009=\u20090.8 [0.58\u20130.96], p\u2009=\u20090.002). There was no difference in the rate of composite adverse maternal (14.0 vs. 15.4%, OR\u2009=\u20090.9 [0.7\u20131.0], p\u2009=\u20090.1) or neonatal outcome (5.3 vs. 4.5%, OR\u2009=\u20091.2 [0.9\u20131.5], p\u2009=\u20090.15). Neonates had a slightly lower mean birth weight (3,474 vs. 3,505\u2009g, p\u2009=\u20090.04) but the rate of SGA was similar in the two groups (2.5 vs. 1.8%, OR\u2009=\u20091.3 [0.9\u20132.0], p\u2009=\u20090.08).<\/jats:p><jats:p>\n            Conclusion\u2003Pregnant women whose OGTT curve is flat have a lower risk of delivering macrosomic neonates and undergoing unplanned cesarean delivery and are not at increased risk of adverse maternal or neonatal outcomes. More research is required to evaluate the relationship between different OGTT curves and the fetal growth rate.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-2405-1909","type":"journal-article","created":{"date-parts":[[2024,8,29]],"date-time":"2024-08-29T23:35:36Z","timestamp":1724974536000},"page":"478-485","source":"Crossref","is-referenced-by-count":5,"title":["The Implications of a \u201cFlat\u201d Oral Glucose Tolerance Test Curve in Pregnancy"],"prefix":"10.1055","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5304-2296","authenticated-orcid":false,"given":"Miriam","family":"Lopian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ma'ayanei Hayeshua Medical Center, Bnei Brak, Israel"},{"name":"School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ella","family":"Segal","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ma'ayanei Hayeshua Medical Center, Bnei Brak, Israel"},{"name":"School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Neiger","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of South Carolina, Columbia, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Many","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ma'ayanei Hayeshua Medical Center, Bnei Brak, Israel"},{"name":"School of Medicine, Tel Aviv University, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7339-2250","authenticated-orcid":false,"given":"Lior","family":"Kashani Ligumsky","sequence":"additional","affiliation":[{"name":"Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of Medicine, UCLA, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,9,19]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/S0002-9378(98)70267-4","article-title":"Longitudinal changes in body composition and energy balance in lean women with normal and abnormal glucose tolerance during pregnancy","volume":"179","author":"P M Catalano","year":"1998","journal-title":"Am J Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13098-019-0406-1","article-title":"The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis","volume":"11","author":"S Behboudi-Gandevani","year":"2019","journal-title":"Diabetol Metab Syndr"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1097\/AOG.0000000000002501","article-title":"ACOG Practice Bulletin No. 190: Gestational diabetes mellitus","volume":"131","author":"American College of Obstetricians and Gynecologists","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"e002264","DOI":"10.1136\/bmjdrc-2021-002264","article-title":"Shape of the OGTT glucose response curve: relationship with \u03b2-cell function and differences by sex, race, and BMI in adults with early type 2 diabetes treated with metformin","volume":"9","author":"K M Utzschneider","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/S0002-9378(86)80004-7","article-title":"A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation","volume":"155","author":"O Langer","year":"1986","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"313","DOI":"10.2337\/cd20-0099","article-title":"Flat oral glucose tolerance test during pregnancy: maternal characteristics and risk for adverse outcomes","volume":"39","author":"A Naeh","year":"2021","journal-title":"Clin Diabetes"},{"issue":"09","key":"ref7","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1038\/s41372-023-01691-8","article-title":"Flat maternal glucose response curve and adverse pregnancy outcome","volume":"43","author":"I Navon","year":"2023","journal-title":"J Perinatol"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1046\/j.1469-0705.1993.03060412.x","article-title":"Second-trimester uterine artery flow velocity waveform and oral glucose tolerance test as a means of predicting intrauterine growth retardation","volume":"3","author":"H Valensise","year":"1993","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"11","key":"ref9","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1111\/aogs.12365","article-title":"Association between low blood glucose increase during glucose tolerance tests in pregnancy and impaired fetal growth","volume":"93","author":"T Rogne","year":"2014","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"07","key":"ref10","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/0002-9378(82)90349-0","article-title":"Criteria for screening tests for gestational diabetes","volume":"144","author":"M W Carpenter","year":"1982","journal-title":"Am J Obstet Gynecol"},{"issue":"05","key":"ref11","first-page":"311","article-title":"Birth weight standards in the live-born population in Israel","volume":"7","author":"S Dollberg","year":"2005","journal-title":"Isr Med Assoc J"},{"issue":"01","key":"ref12","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0020-7292(02)00092-9","article-title":"The Hyperglycemia and Adverse Pregnancy Outcome (Hapo) study","volume":"78","author":"M Contreras","year":"2002","journal-title":"Int J Gynecol Obstet"},{"issue":"12","key":"ref13","doi-asserted-by":"crossref","first-page":"1315","DOI":"10.1007\/BF00400812","article-title":"Relation of birthweight to maternal plasma glucose and insulin concentrations during normal pregnancy","volume":"36","author":"M C Breschi","year":"1993","journal-title":"Diabetologia"},{"issue":"03","key":"ref14","first-page":"148","article-title":"Association of maternal hypoglycemia with low birth weight and low placental weight: a retrospective investigation","volume":"111","author":"E S Vadakekut","year":"2011","journal-title":"J Am Osteopath Assoc"},{"issue":"12","key":"ref15","doi-asserted-by":"crossref","first-page":"e013749","DOI":"10.1136\/bmjopen-2016-013749","article-title":"Relationship between maternal hypoglycaemia and small-for-gestational-age infants according to maternal weight status: a retrospective cohort study in two hospitals","volume":"6","author":"S Shinohara","year":"2016","journal-title":"BMJ Open"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1038\/sj.jp.7200048","article-title":"Maternal hypoglycemia: is it associated with adverse perinatal outcome?","volume":"19","author":"E F Calfee","year":"1999","journal-title":"J Perinatol"},{"issue":"08","key":"ref17","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.2337\/dc16-0352","article-title":"The shape of the glucose response curve during an oral glucose tolerance test heralds biomarkers of type 2 diabetes risk in obese youth","volume":"39","author":"J Y Kim","year":"2016","journal-title":"Diabetes Care"},{"issue":"7570","key":"ref18","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/S0140-6736(68)90747-2","article-title":"Influence of gastric emptying-rate and of insulin response on oral glucose tolerance in thyroid disease","volume":"2","author":"C D Holdsworth","year":"1968","journal-title":"Lancet"},{"issue":"02","key":"ref19","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/S0377-1237(01)80129-5","article-title":"Is beta cell dysfunction responsible for flat glucose tolerance curve in primary hypothyroidism? (A hypothesis)","volume":"57","author":"R Pakhetra","year":"2001","journal-title":"Med J Armed Forces India"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.clinbiochem.2022.08.010","article-title":"Incidence and status of insulin secretion in pregnant women with flat plasma glucose profiles during oral glucose tolerance test","volume":"109\u2013110","author":"D Szoke","year":"2022","journal-title":"Clin Biochem"},{"issue":"05","key":"ref21","doi-asserted-by":"publisher","DOI":"10.15761\/cogrm.1000266","article-title":"Intrauterine growth restriction: recent developments, definitions and future research","volume":"5","author":"R A McMaster-Fay","year":"2019","journal-title":"Clin Obstet Gynecol Reprod Med"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.bpobgyn.2016.09.003","article-title":"Role of uteroplacental and fetal Doppler in identifying fetal growth restriction at term","volume":"38","author":"A Khalil","year":"2017","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/S0140-6736(23)02228-6","article-title":"Term planned delivery based on fetal growth assessment with or without the cerebroplacental ratio in low-risk pregnancies (RATIO37): an international, multicentre, open-label, randomised controlled trial","volume":"403","author":"M Rial-Crestelo","year":"2024","journal-title":"Lancet"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"218598","DOI":"10.1155\/2011\/218598","article-title":"Maternal diabetes in pregnancy: early and long-term outcomes on the offspring and the concept of \u201cmetabolic memory\u201d","volume":"2011","author":"A Yessoufou","year":"2011","journal-title":"Exp Diabetes Res"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1203\/PDR.0b013e3182115000","article-title":"Influence of insulin-like growth factor I and nutrition during phases of postnatal growth in very preterm infants","volume":"69","author":"I Hansen-Pupp","year":"2011","journal-title":"Pediatr Res"},{"issue":"14","key":"ref26","doi-asserted-by":"crossref","first-page":"2999","DOI":"10.1017\/S0033291716001598","article-title":"Maternal prenatal depression is associated with decreased placental expression of the imprinted gene PEG3","volume":"46","author":"A B Janssen","year":"2016","journal-title":"Psychol Med"},{"issue":"02","key":"ref27","first-page":"135","article-title":"Adipose tissue development \u201cin utero\u201d. Relationships between some nutritional and hormonal factors and body fat mass enlargement in newborns","volume":"18","author":"G Enzi","year":"1980","journal-title":"Diabetologia"},{"issue":"05","key":"ref28","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1210\/jc.2010-0023","article-title":"Differential expression profile of growth hormone\/chorionic somatomammotropin genes in placenta of small- and large-for-gestational-age newborns","volume":"95","author":"J M\u00e4nnik","year":"2010","journal-title":"J Clin Endocrinol Metab"},{"issue":"03","key":"ref29","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1530\/JOE-18-0093","article-title":"Chorionic somatomammotropin impacts early fetal growth and placental gene expression","volume":"237","author":"K M Jeckel","year":"2018","journal-title":"J Endocrinol"},{"issue":"05","key":"ref30","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/S0143-4004(84)80026-0","article-title":"Relationship of maternal and fetal levels of human placental lactogen to the weight and sex of the fetus","volume":"5","author":"D J Houghton","year":"1984","journal-title":"Placenta"},{"key":"ref31","first-page":"50","article-title":"Prediction of fetal growth based on maternal serum concentrations of human chorionic gonadotropin, human placental lactogen and estriol","volume":"165","author":"T Markestad","year":"1997","journal-title":"Acta Obstet Gynecol Scand Suppl"},{"issue":"11","key":"ref32","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1111\/j.1471-0528.1985.tb03026.x","article-title":"Placental protein 12 (PP12): a new test for the prediction of the small-for-gestational-age infant","volume":"92","author":"R JS Howell","year":"1985","journal-title":"Br J Obstet Gynaecol"},{"issue":"02","key":"ref33","doi-asserted-by":"crossref","first-page":"e055257","DOI":"10.1136\/bmjopen-2021-055257","article-title":"Lactogenic hormones in relation to maternal metabolic health in pregnancy and postpartum: protocol for a systematic review","volume":"12","author":"K L Rassie","year":"2022","journal-title":"BMJ Open"},{"issue":"01","key":"ref34","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1067\/mob.2002.119176","article-title":"Increased apoptosis in the syncytiotrophoblast in human term placentas complicated by either preeclampsia or intrauterine growth retardation","volume":"186","author":"N Ishihara","year":"2002","journal-title":"Am J Obstet Gynecol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/B978-0-323-82823-9.00003-9","volume-title":"Development, function, and pathology of the placenta","author":"E Maltepe","year":"2024","edition":"11th ed."},{"key":"ref36","first-page":"13","volume-title":"Fetal monitoring: biochemical methods","author":"A Klopper","year":"1987"},{"issue":"06","key":"ref37","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/0002-9378(77)90647-0","article-title":"Further investigation on the predictive value of human placental lactogen in high-risk pregnancies","volume":"129","author":"M Granat","year":"1977","journal-title":"Am J Obstet Gynecol"},{"issue":"8071","key":"ref38","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/S0140-6736(78)90247-7","article-title":"Clinical application of human-placental-lactogen values in late pregnancy","volume":"1","author":"A T Letchworth","year":"1978","journal-title":"Lancet"},{"issue":"04","key":"ref39","first-page":"446","article-title":"Human placental lactogen and intrauterine growth retardation","volume":"47","author":"W N Spellacy","year":"1976","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref40","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/j.1471-0528.1975.tb00633.x","article-title":"An evaluation of human placental lactogen levels in hypertension of pregnancy","volume":"82","author":"A M Kelly","year":"1975","journal-title":"Br J Obstet Gynaecol"},{"issue":"12","key":"ref41","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1111\/j.1471-0528.1973.tb02978.x","article-title":"Human placental lactogen (HPL) levels in abnormal pregnancies","volume":"80","author":"B S Lindberg","year":"1973","journal-title":"J Obstet Gynaecol Br Commonw"},{"issue":"14","key":"ref42","doi-asserted-by":"crossref","first-page":"5478","DOI":"10.1073\/pnas.0508035103","article-title":"Gene expression patterns in human placenta","volume":"103","author":"R Sood","year":"2006","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"9199","key":"ref43","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/S0140-6736(99)05061-8","article-title":"Sexual origins of placental dysfunction","volume":"355","author":"A Edwards","year":"2000","journal-title":"Lancet"},{"issue":"04","key":"ref44","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1002\/ajmg.a.35250","article-title":"Male sex bias in placental dysfunction","volume":"158A","author":"A Murji","year":"2012","journal-title":"Am J Med Genet A"},{"issue":"01","key":"ref45","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1471-2393-14-63","article-title":"Fetal growth restriction and the risk of perinatal mortality-case studies from the multicentre PORTO study","volume":"14","author":"J Unterscheider","year":"2014","journal-title":"BMC Pregnancy Childbirth"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2405-1909.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T23:32:05Z","timestamp":1740439925000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2405-1909"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,29]]},"references-count":45,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2025,2,24]]},"published-print":{"date-parts":[[2025,3]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2405-1909","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,8,29]]},"published":{"date-parts":[[2024,8,29]]}}}