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Flat maternal glucose response curve and adverse pregnancy outcome



The significance of a flat oral glucose tolerance test (OGTT) response curve in pregnancy remains unclear. We investigated the association of a flat curve with pregnancy outcomes.

Study design

Retrospective cohort study. Flat OGTT curve was defined by an area under the curve below the 10th percentile. Pregnancy outcomes were compared between flat and normal curve.


Of the 2673 eligible women, 269 had a flat response curve. Compared with the normal-response group, the flat-curve group had a lower mean birthweight (3363 ± 547 g vs. 3459 ± 519 g, p < 0.005), higher probability of small for gestational age (SGA) (19% vs. 12%, p < 0.005, aOR = 1.75, 95% CI 1.24–2.47), and 5-min Apgar score < 7 (1.12% vs. 0.29%, p < 0.05, aOR = 3.95, 95% CI 1.01–15.5). There were no differences in obstetric or maternal outcomes.


Flat OGTT is associated with lower birthweight, higher rates of SGA, and low Apgar scores. Detecting this previously unrecognized risk group, could potentially reduce these complications.

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Fig. 1


  1. Group HSCR. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.

  2. Langer O, Rodriguez DA, Xenakis EMJ, McFarland MB, Berkus MD, Arredondo F. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol. 1994;1701036-46; discussion 1046-7.

  3. Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Engl J Med. 1999;341.

  4. Langer O, Damus K, Maiman M, Divon M, Levy J, Bauman W. A link between relative hypoglycemia-hypoinsulinemia during oral glucose tolerance tests and intrauterine growth retardation. Am J Obstet Gynecol. 1986;155:711–6.

    Article  CAS  PubMed  Google Scholar 

  5. Naeh A, Wilkof-Segev R, Jaffe A, Maor-Sagie E, Hallak M, Gabbay-Benziv R. Flat oral glucose tolerance test during pregnancy: maternal characteristics and risk for adverse outcomes. Clin Diab. 2021;39:313–319.

  6. Valensise H, Romanini C. Second-trimester uterine artery flow velocity waveform and oral glucose tolerance test as a means of predicting intrauterine growth retardation. Ultrasound Obstet Gynecol. 1993;3:412–6.

  7. Mccowen MKD.O’sarr TP. Clinical implications of the flat oral glucose tolerance test. Mil Med. 1979;144:177–9.

  8. Pakhetra R, Garg MK, Saini JS. Is beta cell dysfunction responsible for flat glucose tolerance curve in primary hypothyroidism? Med J Armed Forces India. 2001;57:120–5.

  9. Das Gupta DS, Whitehouse FW. Significance of the flat oral glucose tolerance test. Postgraduate Med. 2016;49:55–9.

    Google Scholar 

  10. Nolan S, Stephan T, Khurana KC, Morgan CR, Danowski TS. Low profile (flat) glucose tolerances. Am J Med Sci. 1972;264:33–9.

    Article  CAS  PubMed  Google Scholar 

  11. Abell DA. The significance of abnormal glucose tolerance (hyperglycaemia and hypoglycaemia) in pregnancy. Br J Obsteirics. 1979;86:214–21.

    Article  CAS  Google Scholar 

  12. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144:768–73.

    Article  CAS  PubMed  Google Scholar 

  13. Nicolaides KH, Wright D, Syngelaki A, Wright A, Akolekar R. Fetal medicine foundation fetal and neonatal population weight charts. Ultrasound Obstet Gynecol. 2018;52:44–51.

    Article  CAS  PubMed  Google Scholar 

  14. Soothill PW, Nicolaides KH, Campbell S. Prenatal asphyxia, hyperlacticaemia, hypoglycaemia, and erythroblastosis in growth retarded fetuses. BMJ 1987;294:1051–3.

  15. Thorn S, Rozance P, Brown L, Hay W. The intrauterine growth restriction phenotype: Fetal adaptations and potential implications for later life insulin resistance and diabetes. Sem Reprod Med. 2011;29:225–36

  16. Brody S. Screening for gestational diabetes: a summary of the evidence for the U.S. preventive services task force. Obstet Gynecol. 2003;101:531–8.

  17. Coustan DR, Carpenter MW. The diagnosis of gestational diabetes. Diab Care. 1998;21:B5–8.

  18. Abell DA, Beischer NA. Evaluation of the three-hour oral glucose tolerance test in detection of dignificant hyperglycemia and hypoglycemia in pregnancy. Diabetes. 1975;24:874–80.

  19. Abell DA, Beischer NA, Papas AJ, Willis MM. The association between abnormal glucose tolerance (hyperglycemia and hypoglycemia) and estriol excretion in pregnancy. Am J Obstet Gynecol. 1976;124:388–92.

  20. Bayraktar B, Meriç B, Ahkam GK. Pregnancy outcomes of women with hypoglycemia in the oral glucose tolerance test. J Gynecol Obstet Human Reprod. 2020;49.

  21. Weissman A, Solt I, Zloczower M, Jakobi P. Hypoglycemia during the 100-g oral glucose tolerance test: incidence and perinatal significance. Obstet Gynecol. 2005;105:1424–8.

  22. Sheiner E, Levy A, Katz M, Hershkovitz R, Leron E, Mazor M. Gender does matter in perinatal medicine. Fetal Diag Therapy. 2004;19:366–9.

  23. Retnakaran R, Kramer CK, Ye C, Kew S, Hanley AJ, Connelly PW, et al. Fetal sex and maternal risk of gestational diabetes mellitus: the impact of having a boy. Diabet Care. 2015;38:844–51.

  24. Krantz D, Goetzl L, Simpson JL, Thom E, Zachary J, Hallahan T. W, et al. Association of extreme first-trimester free human chorionic gonadotropin-beta, pregnancy-associated plasma protein A, and nuchal translucency with intrauterine growth restriction and other adverse pregnancy outcomes. Am J Obstet Gynecol. 2004;191:1452–8.

    Article  CAS  PubMed  Google Scholar 

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



I.N.: Conceived the main research question, conceptualization, project administration, data curation, investigation, formal analysis, writing – original draft. A.R.: Data curation, project administration. A.P.: data curation, project administration. R.M.: Data curation, project administration. Y.T.: writing – review, S.B.H.: Data curation, project administration. E.H.: conceptualization, supervision, writing – review and editing.

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Correspondence to Inbal Navon.

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Navon, I., Romano, A., Pardo, A. et al. Flat maternal glucose response curve and adverse pregnancy outcome. J Perinatol 43, 1101–1104 (2023).

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