Solely Elevated Fasting Glucose Level In Glucose Tolerance Test: A Dilemma For Diagnosis of GDM

Solely Elevated Fasting Glucose Level In Glucose Tolerance Test: A Dilemma For Diagnosis of GDM | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Solely Elevated Fasting Glucose Level In Glucose Tolerance Test: A Dilemma For Diagnosis of GDM Dinçer Sümer, Ahmet Arif Filiz, Özge Öztürk, Türkan Dikici Aktaş, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7307293/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate and compare obstetric and neonatal outcomes of pregnant women with solely elevated fasting glucose levels who were diagnosed with gestational diabetes mellitus (GDM) using the 75-gram OGTT approach with those who were not diagnosed with GDM using the 100-gram OGTT approach. Methods This retrospective study was conducted at Etlik City Hospital, Ankara, Türkiye, and included pregnant women who underwent either a 75-gram or a 100-gram OGTT between January 2023 and March 2025 between 24 and 32 weeks of gestation. The participants were categorized into three groups: Group 1; with a diagnosis of GDM based on solely elevated fasting blood glucose during the 75-gram OGTT. Group 2; not diagnosed with GDM despite elevated fasting glucose during the 100-gram OGTT. Group 3; diagnosed with GDM due to an otherwise positive value in the 75-gram OGTT approach except for the solely fasting glucose level. Obstetric and neonatal outcomes, diabetes parameters, insulin therapy requirement,and birth characteristics were analysed and compared between groups. Results Fasting glucose levels were significantly higher in group 2 compared to the other groups (p = 0.001). No patient in group 1 required insulin, while 11.8% of group 2 and 27.3% of group 3 required insulin therapy (p = 0.025). Neonatal blood glucose levels were significantly lower in group 3 compared to group 2 (p = 0.006). Requirement for insulin therapy, polyhydramnios, preterm birth, LGA, caesarean section, admission of the newborn to the intensive care unit and the duration of admission to the intensive care unit were comparable between group 2 and group 3. Conclusion Solely elevated fasting glucose levels, at diagnostic test for GDM, are associated with adverse obstetric and neonatal outcomes. These findings support the inclusion of solely elevated fasting glucose level as a diagnostic criterion for GDM and point to the need for standardised treatment of these patients, regardless of the OGTT method used. Gestational diabetes mellitus fasting glucose OGTT one-step approach two-step approach obstetric outcomes neonatal outcomes Figures Figure 1 Introduction condition that is associated with significant maternal and fetal adverse outcomes[ 1 , 2 ]. Early detection and appropriate treatment of GDM is crucial to minimise perinatal complications [ 2 ]. International guidelines recommend that all pregnant women at increased risk should be screened for gestational diabetes between 24 and 28 weeks' gestation[ 3 , 4 ]. There are two primary approaches to screening and diagnosing GDM. The first is a one-step approach: a 75-gram oral glucose tolerance test (OGTT). According to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) [ 5 ], GDM is diagnosed when one of the following plasma glucose levels is reached or exceeded: Fasting ≥ 92 mg/dL, 1 hour ≥ 180 mg/dL, or 2 hours ≥ 153 mg/dL. The other method is a two-step approach: first, a 50-gram glucose challenge test is performed. If the 1-hour plasma glucose level is ≥ 140 mg/dL, a subsequent 100-gram OGTT is recommended. The diagnostic thresholds for the 100-gram OGTT are: Fasting ≥ 95 mg/dL, 1 hour ≥ 180 mg/dL, 2 hours ≥ 155 mg/dL and 3 hours ≥ 140 mg/dL. For a diagnosis of GDM, at least two values must meet or exceed these thresholds [ 6 ]. There is no consensus on the best approach for a diagnostic test for GDM. The American Collage of Obstetric and Gynaecology (ACOG) recommends a two-stage approach, the International Association of Diabetes and Pregnancy Study Groups, the International Federation of Gynaecology and Obstetrics, the World Health Organisation and the National Institute for Health and Care Excellence recommend a one-stage approach,the American Diabetes Association and the Canadian Diabetes Association (CDA) recommend either two approaches to diagnosis [ 3 – 5 , 7 – 10 ]. And there is also ongoing controversy about these approaches [ 3 , 11 , 12 ]. An important discrepancy between these two approaches arises when the fasting blood glucose level is elevated but the postprandial blood glucose level is normal. Solely elevated fasting blood glucose level is a diagnostic criterion for GDM according to the 75 gram OGTT criteria. However, the same fasting blood glucose level determined with the 100-gram OGTT would not receive a GDM diagnosis if there is no elevated postprandial blood glucose level. The main objective of this study is to evaluate and compare the obstetric and neonatal outcomes of pregnant women diagnosed with GDM according to the 75-gram OGTT criteria or not diagnosed with GDM according to the 100-gram OGTT criteria, based on solely elevated fasting glucose levels. Materials and Methods This study planned to be conducted in the perinatology clinic of Etlik City Hospital, Ankara, Türkiye. The data were obtained retrospectively from the hospital's electronic medical record system. The study includes pregnant women who underwent a one–step GTT (75-gram GTT) or a two-step GTT (50-gram glucose load test followed by a 100-gram OGTT) between 24–32 gestational week, between January 2023 and March 2025 and delivered at the same hospital. The participants were categorised into the following three groups. Patients who were diagnosed with GDM based on solely elevated fasting plasma glucose levels during the 75-gram OGTT were included in Group 1. Patients with solely elevated fasting plasma glucose levels during the 100-gram OGTT who were not diagnosed with GDM were included in Group 2. And patients who were diagnosed with GDM and had otherwise elevated levels during the 75-gram OGTT, except for an solely elevated fasting plasma glucose level, were included in group 3. Multiple pregnancies, patients whom lost for follow up, in whom the OGTT was performed before 23 weeks' gestation, in whom inflammatory disease was present and those taking corticosteroids were excluded from the study. The flow chart of the study is shown in Fig. 1 . The local ethics committee approved the study. In patients diagnosed with GDM on the basis of the OGTT, a two-week diet was recommended and the fasting and postprandial serum glucose values of the first hour were monitored in hospital. The target values were set at 95mg/dL for the fasting value and 140mg/dL for the postprandial value of the first hour. Patients whose glucose levels were below the target values were advised to follow a diet and have their glucose levels reassessed weekly. Patients whose glucose levels were above the target values were recommended insulin therapy. Insulin therapy is individualised and adapted to the advancing gestational age. No diet was recommended for patients with elevated fasting glucose levels in the 100 gram OGTT, but regular reassessment of fasting and postprandial serum glucose levels at two-week intervals was recommended. The target glucose values were determined as GDM-positive patients. Patients whose glucose levels were above the target levels were advised to follow a diet, and if the diet was not yet completed, insulin therapy was recommended. Oligohydramnios is defined as a maximum vertical pocket of less than 2 cm and polyhydramnios is defined as a maximum vertical pocket of 8 cm or more [ 13 ].Preterm birth was defined as delivery before 37 weeks' gestation [ 14 ]. Fetal growth restriction (FGR) and small-for-gestational-age (SGA) were defined according to the Delphi consensus [ 15 ]. Gestational hypertension and pre-eclampsia were defined according to the ACOG guideline [ 16 ]. Cholestatis of pregnancy, defined as new-onset pruritis during pregnancy and elevated serum bile acid levels [ 17 ]. Sholderdystocia, defined according to the ACOG guideline [ 18 ]. Statistical analysis The Statistical Package for the Social Sciences Version 22.0 (IBM Corporation, Armonk, New York, US) was used to analyse the data, with the significance level for the analysis set at p < 0.05. The Kolmogrov-Simirnov and Shapiro-Wilk test was used to determine the distribution of the data. The Kruskal-Wallis test, analysis of variance (ANOVA) and the chi-square test or Fisher’s exact test were used to compare the groups. The Leneve test was used to determine the homogeneity of variance. The Mann-Whitney U test with Benforri correction and the Tukey test were used for the post-hoc analysis of the numerical data. The chi-square test or Fisher’s exact test was used for the post-hoc analysis of categorical data. Median and interquartile ranges (median, IQR) were used for non-normally distributed numerical data. Categorical variables were expressed as frequency and percentage (n,%). Results The mean age of the groups was 31.26 ± 1.59, 29.82 ± 1.26 and 34.53 ± 0.50 respectively(p = 0.001), whereby the mean age of group 3 was significantly higher than that of the other groups (group1 vs. group3 p = 0.023 and group2 vs. group3 p = 0.004). The median number of abortus was 1.0(1.0), 0.0(0.0) and 0.0(1.0) for groups respectively(p = 0.013) and group 1 had significantly more abortus than group 2 (group 1 vs. group 2 p = 0.002). The demographic characteristics of the groups are summarised in Table 1 . Table 1 Demographic characteristics of the groups. IQR interquantil range, SD: standart deviation, 1 ANOVA, 2 Kruskal-Wallis test, 3 Fischer’s exact test, 4 Tukey test, 5 Mann-Whitney U test with Benforri correction(p < 0.016 for significance), a Did not calculated Parameter Group 1 n:19 Group 2 n:17 Group 3 n:99 p value Post hoc analysis Group1 vs group2 Group1 vs group3 Group2 vs group3 Age (year,mean ± SD) 31.26 ± 1.59 29.82 ± 1.26 34.53 ± 0.50 p = 0.001 1 p = 0.699 p = 0,023 4 p = 0,004 4 Gravida (n,median,IQR) 3.0 (4.0) 2.0(2.0) 3.0(2.0) p = 0.138 2 p = 0.174 p = 0.920 p = 0.045 5 Parity(n,median,IQR) 1.0(2.0) 1.0(2.0) 1.0(2.0) p = 0.417 2 p = 0.973 p = 0.321 p = 0.311 Abortus(n,median,IQR) 1.0(1.0) 0.0(0.0) 0.0(1.0) p = 0.013 2 p = 0.002 5 p = 0.112 p = 0.028 5 Method of conception (ın-vitro fertilization, n,%) 0(0%) 0(0%) 2(2.0%) p = 1.000 3 - p = 1.000 p = 1.000 The median week of gestation for the OGTT was 26.0(4.0), 26.0(3.0) and 26.0(2.0) for groups respectively and was not significant (p = 0.103). Fasting glucose levels atthe OGTT were 95.0(5.0) mg/dL, 101.0(14.0) mg/dL and 85.0(23.0) mg/dL, respectively, and were significantly different between the groups (p = 0.001). All three groups had significantly different fasting glucose levels from each other(p = 0.001, p = 0.001, p = 0.001). Twenty-seven (27.3%) patients in group 3 and two (11.8%) patients in group 2 required insulin therapy during follow-up. There were no patients in group 1 who required insulin therapy. The need for insulin therapy was significant for the groups (p = 0.025). Significantly more patients required insulin therapy in group 3 than in group 1 (p = 0.012). The total number of hospitalisations during pregnancy, total duration of hospitalisation, body mass index (BMI) at birth, weight gain during pregnancy and duration of hospitalisation after birth were not significant for the groups (p > 0.05). The parameters are summarised in Table 2 . Table 2 Parameters of the groups associated with diabetes mellitus. OGTT: Oral Glucose Tolerance Test, BMI: Body Mass Index, 1 Fischer’s exact test, 2 Kruskal-Wallis test, 3 Mann-Whitney U test, 4 Mann-Whitney U test with Benforri correction (p < 0.016 for significance), a did not calculated. Parameter Group1 n:19 Group2 n:17 Group3 n:99 p value Post hoc analysis Group1 vs group2 Group1 vs group3 Group2 vs group3 Gestational age at OGTT (week, median,IQR) 26.0(4.0) 26.0(3.0) 26.0(2.0) p = 0.103 2 p = 0.137 p = 0.858 p = 0.033 4 Fasting glucose level at OGTT (mg/dL, median,IQR) 95.0(5.0) 101.0(14.0) 85.0(23.0) p = 0.001 2 p = 0.001 4 p = 0.001 4 p = 0.001 4 Insuline therapy(n,%) 0(0%) 2 (11.8%) 27 (27.3%) p = 0.025 1 p = 0.216 p = 0.012 1 p = 0.353 Total number of hospitalization (n, median,IQR) 0.0(0.0) 0.0(0.0) 0.0(1.0) p = 0.119 2 p = 0.195 p = 0.450 p = 0.048 4 Total duration of Hospitalization (day, median,IQR) 0.0(2.0) 0.0(0.0) 0.0(2.0) p = 0.106 2 p = 0.092 p = 0.660 p = 0.036 4 BMI at birth (kg/m 2 , median,IQR) 33.0(6.0) 33.0(10.0) 32.0(8.0) p = 0.165 2 p = 0.474 p = 0.068 p = 0.427 Weight gain during pregnancy (kg, median,IQR) 10.0(13.0) 12.0(11.0) 10.0(5.0) p = 0.832 2 p = 0.645 p = 0.693 p = 0.667 Duration of hospitalization after birth(day, median,IQR) 2.0(0.0) 2.0(1.0) 2.0(0.0) p = 0.313 2 p = 0.183 p = 0.676 p = 0.171 Seventeen (17.2%) patients in group 3 and 4 (23.5%) patients in group 2 had polyhydramnios. There was no polyhydramnios in group 1. The difference between the groups was significant (p = 0.070). The rate of polyhydramnios was similar in group 2 and group 3 and significantly higher than in group 1 (group 1 vs. group 2 p = 0.040, group 1 vs. group 3 p = 0.071 and group 2 vs. group 3 p = 0.507). Two (10.5%) patients in group 1, 1 (5.9%) patient in group 2 and 4 (4.0%) patients in group 3 were found to have a large for gestational age at ultrasound examination during follow-up. The difference between the groups was not significant (p = 0.346). Sixteen (84.2%) patients in group 1, 11 (64.7%) patient in group 2 and 80 (80.8%) patients in group 3 underwent caesarean section. The difference between the groups was not significant (p = 0.493). There was no intrauterine death or abruptio placenta in the study groups. One patient in group 3 had a sholder dystocia at birth. Oligohydramnios, small for gestational age, fetal growth restriction, preterm labour, gestational hypertension, pre-eclampsia, large for gestational age (LGA), cholestasis of pregnancy were not significant for the groups (p > 0.05). The obstetric outcomes of the groups are summarised in Table 3 . Table 3 Obstetric outcomes of the groups, 1 Fischer’s exact test, 2 Chi-square test, a did not calculated. Parameter Group1 n:19 Group2 n:17 Group3 n:99 p value Post hoc analysis Group1 vs group2 Group1 vs group3 Group2 vs group3 Polyhydramnios (n,%) 0(0%) 4(23.5%) 17(17.2%) p = 0.070 1 p = 0,040 1 p = 0.071 1 p = 0.507 Oligohydramnios(n,%) 2(10.5%) 1(5.9%) 5(5.1%) p = 0.595 1 p = 1.000 p = 0.314 p = 1.000 Small for gestaional Age (n,%) 0(0%) 0(0%) 1(1.0%) p = 1.000 1 - p = 1.000 p = 1.000 Fetal growth restriction(n,%) 1(5.3%) 1(5.9%) 1(1.0%) p = 0.173 1 p = 1.000 p = 0.297 p = 0.273 Preterm labour (n,%) 1(5.3%) 2(11.8%) 14(14.3%) p = 0.639 1 p = 0.593 p = 0.460 p = 1.000 Abruptio placenta(n,%) 0(0%) 0(0%) 0(0%) - a - a - a - a Intra-uterine exitus(n,%) 0(0%) 0(0%) 0(0%) - a - a - a - a Gestational Hypertension(n,%) 3(15.8%) 0(0%) 13(13.1%) p = 0.299 1 p = 0.234 p = 0.721 p = 0.209 Pre-eclampsia(n,%) 3(15.8%) 1(5.9%) 3(11.1%) p = 0.740 1 p = 0.605 p = 0.697 p = 0.513 Cholestasis of Pregnancy (n,%) 0(0%) 0(0%) 1(1.0%) p = 1.000 1 - p = 1.000 p = 1.000 Large for gestational Age (> 4000gram,n,%) 2(10.5%) 1(5.9%) 4(4.0%) p = 0.346 1 p = 1.000 p = 0.248 p = 0.544 Ceasarean Section(n,%) 16(84.2%) 11(64.7%) 80(80.8%) p = 0.493 2 p = 0.177 p = 1.000 p = 0.310 Sholder dystocia (n,%) 0(0%) 0(0%) 1(1.0%) p = 1.000 1 - p = 1.000 p = 1.000 Gestational age at delivery was 38.0(2.0), 39.0(3.0) and 38.0(2.0) for groups and was not significant (p = 0.521). The weight of the newborn was 3229 ± 120gr, 3283 ± 130gr and 3131 ± 63gr for the groups, respectively, and the difference was not significant (p = 0.559). The APGAR score at 1 and 5 minutes and the pH of the cord blood sample at birth were not significant for the groups (p > 0.05). The median blood glucose level of the newborn was 69.0(30.3)mg/dL, 66.0(9.0)mg/dL and 61.0(25.0)mg/dL for groups respectively. The difference was statistically significant for the groups (p = 0.012). The difference in glucose levels was not significant for group 1 versus group 2 (p = 0.295) and group 1 versus group 3 (p = 0.124). Group 3 had a significantly lower glucose level than group 2 (group 2 vs. group 3 p = 0.006). Two (10.5%) newborns in group 1, 3 (18.8%) in group 2 and 24 (24.2%) in group 3 were admitted to the neonatal intensive care unit (NICU). The hospitalisation rate was not significantly different between the groups (p = 0.451). The duration of hospitalisation of the newborn in the NICU was not significantly different between the groups (p = 0.572). There was one neonatal death in group 3. A summary of the neonatal outcomes is shown in Table 4 . Table 4 Neonatal outcome characteristics of the groups, NICU: Neonatal Intensive Care Unit, 1 Fischer’s exact test, 2 Kruskal-Wallis test, 3 ANOVA, 4 Mann-Whitney U test with Benforri correction (p < 0.016 for significance) Parameter Group1 n:19 Group2 n:17 Group3 N:99 p value Post hoc analysis Group1 vs group2 Group1 vs group3 Group2 vs group3 Gestational age at delivery (week, median,IQR) 38.0(2.0) 39.0(3.0) 38.0(2.0) p = 0.521 2 p = 0.731 p = 0.443 p = 0.346 Weight of the newborn(gram, mean ± SD) 3229 ± 120 3283 ± 130 3131 ± 63 p = 0.559 3 p = 0.762 p = 0.526 p = 0.351 APGAR score 1rd minute 8(1) 9(2) 9(1) p = 0.531 2 p = 0.277 p = 0.426 p = 0.503 APGAR score 5th minute 9(1) 10(2) 10(1) p = 0.658 2 p = 0.401 p = 0.513 p = 0.576 pH level of umblical cord blood at birth 7.37(0.04) 7.34(0.14) 7.37(0.11) p = 0.994 2 p = 0.771 p = 0.933 p = 0.847 Blood glucose level of the newborn (mg/dL, median,IQR) 69.0(30.3) 66.0(9.0) 61.0(25.0) p = 0.012 2 p = 0.295 p = 0.124 p = 0.006 4 NICU admission(n,%) 2(10.5%) 3(18.8%) 24(24.2%) p = 0.451 1 p = 0.642 p = 0.239 p = 631 Duration of hospitalization of the newborn in NICU(day, median,IQR) 0.0(3.0) 2.5(16.0) 0.0(3.0) p = 0.572 2 p = 0.331 p = 0.471 p = 0.507 Neonatal death(n,%) 0(0%) 0(0%) 1(1%) p = 1.000 1 - p = 1.000 p = 1.000 Discussion Fasting glucose level was highest in the solely elevated fasting glucose level at 100 g OGTT group(group 2). 11.8% required insulin therapy during follow-up and was comparable to the otherwise positive 75 g OGTT group (group 3). Polyhydramnios, caesarean section and admission of the newborn to the intensive care unit were increased in this group. All patients in solely elevated fasting glucose level at 75 g OGTT (group 1) did not require insulin therapy at follow-up. LGA, gestational hypertension, pre-eclampsia, caesarean section, admission of the newborn to the intensive care unit were increased in this group and comparable to the otherwise positive 75 g OGTT group (group 3). This study shows that solely elevated fasting glucose level is associated with adverse obstetric and neonatal outcomes and these patients should be managed as GDM-positive patients In a prospective study, 23792 patients were analysed according to the one- or two-step diagnostic test approach and the obstetric and neonatal outcomes of the two groups were examined and compared. In their study, 16.5% of pregnancies assigned to the 1-step approach and 8.5% of pregnancies assigned to the 2-step approach were diagnosed with GDM. In 39% of 1-step GDM cases, the diagnosis was based on isolated fasting plasma glucose alone, and half of these cases met the criteria by having an isolated fasting plasma glucose in the range of 92–94 mg/dl [ 19 ]. A total of 1235 patients underwent a one-step diagnostic test for GDM and 15.1% were positive for the test. 13.9% of the overall positive group, the diagnosis was based on solely elevated fasting glucose level, and the median fasting glucose level in this group in our study was 95.0 mg/dl. Among women with GDM, the percentage of women treated with insulin or hypoglycemic medication were similar for the 1-step versus 2-step methods (42.6% and 45.6%, respectively) in their research[ 19 ]. None of the patients in group 1 required insulin therapy. 27.3% of patients in group 3 required insulin therapy and for patients in group 2 this rate was 11.8% for this study. The incidence of the primary endpoints (LGA, perinatal composite, gestational hypertension/pre-eclampsia and primary caesarean section) did not differ significantly between the groups randomised to the 1-step and 2-step study. It was concluded that despite a doubling of the frequency of GDM diagnosis in the 1-step approach, there were no significant differences between the groups with regard to the risk of any of the primary endpoints [ 19 ]. Polyhydramnios, caesarean section and neonatal ICU admission were increased in all groups and were comparable in our study. Our results show the increased obstetric and neonatal risks for the elevated fasting glucose levels. In 2008, the Canadian Diabetes Association (CDA) recommended a 50 gram glucose load test for diabetes screening during pregnancy and a 75 gram OGTT for diagnosis. Two glucose level above the threshold are considered positive criteria for diagnosis and an elevated level is defined as impaired glucose tolerance (IGT) of pregnancy. They mentioned that untreated GDM and IGT have increased and comparable adverse obstetric and neonatal outcomes [ 20 ]. A study analysed the IADPSG[ 5 ] criteria instead of the CDA[ 20 ] criteria for the assessment of GDM and mentioned that this approach would lead to a considerable increase in the rate of GDM, but this also appears to identify additional women at similar risk of adverse pregnancy outcomes [ 21 ]. In 2018, the CDA updated their guideline and suggested a 50 gram glucose load test for screening, followed by a 75 gram OGTT for diagnosis or a one-step 75 gram OGTT. They re-evaluated the IGT of pregnancy and the diagnostic criteria for GDM and an elevated glucose level was established as a positive criterion for the diagnosis of GDM[ 22 ]. Our results show increased and comparable obstetric and neonatal outcomes for solely elevated fasting glucose level in both the 75 g OGTT and the 100 g OGTT with GDM and are consistent with CDA's diagnostic assessment for GDM. The obstetric and neonatal outcomes of 2038 patients were analysed and compared in a prospective study. 50 gr glucose challenge test followed by 75 gr OGTT performed to diagnose GDM. IADPSG criteria (one or more abnormal values) and Carpenter and Coustan (CC) criteria (two or more abnormal values), but not the postprandial 3rd hour, were used for diagnosis. Patients were divided into three groups. The non-GDM group did not fulfil either the IADPSG or CC criteria, the GDM group was based on the IADPSG criteria but not the CC criteria, and the GDM group was based on the CC criteria. They mentioned that the IADPSG criteria increased the incidence of GDM diagnosis threefold and the IADPSG-based GDM group had significantly higher pre-eclampsia, phototherapy and overall adverse outcomes than the CC-based GDM group [ 23 ]. Rates of gestational hypertension, pre-eclampsia, LGA and caesarean section were not significantly higher in group 1 than in group 2. Polyhydramnios was significantly more common in group 2 than in group 1. Requirement for insulin therapy, polyhydramnios, preterm labour, LGA, caesarean section, admission of the newborn to the ICU and duration of ICU admission were comparable between group 2 and group 3. Our results confirm this research and show the increased and comparable risk for solely elevated fasting glucose level, but not diagnosed and managed as GDM, detected on a 100 gram OGTT. Strengths One of the major strengths of this study is the use of data from a large tertiary care centre, which increases the generalisability of the results. The study fills a significant gap in the literature by directly comparing maternal and neonatal outcomes in pregnancies with solely elevated fasting blood glucose on both 75-gram and 100-gram OGTTs. By categorising patients into three distinct groups based on the diagnostic thresholds of different guidelines, this study provides a nuanced analysis of the clinical impact of fasting hyperglycaemia in pregnancy. In addition, the use of uniform diagnostic criteria, comprehensive follow-up and a standardised treatment algorithm strengthens the internal validity of the results. Limitations This study has several limitations. First, the retrospective design harbours the possibility of selection bias and limits control over confounding variables. Second, the sample size, particularly in groups 1 and 2, was relatively small, which may have limited the power to detect certain statistically significant differences. In addition, the lack of long-term follow-up data for both mothers and newborns limits the assessment of long-term metabolic outcomes. Another limitation is the reliance on a single fasting glucose measurement during the OGTT, which may be subject to biological variation. Finally, the study was conducted in a single centre in Türkiye, so external validity to other populations or health systems may be limited. Conclusion This study shows that an isolated elevated fasting glucose level, regardless of the OGTT method, is associated with increased maternal and neonatal complications. These findings support managing such cases as GDM, even if the current two-step diagnostic criteria are not met. Reviewing the diagnostic thresholds and adjusting clinical treatment protocols accordingly may improve pregnancy outcomes. Abbreviations American Collage of Obstetric and Gynecology(ACOG) Analysis of Variance (ANOVA) Body Mass Index(BMI) Canadian Diabetes Association(CDA) Carpenter and Coustan (CC) Fetal growth restriction (FGR) Gestational diabetes mellitus (GDM) International Association of Diabetes and Pregnancy Study Groups (IADPSG) Interquartile ranges (IQR) Large for gestational age (LGA), Neonatal Intensive Care Unite (NICU). Oral glucose tolerance test (OGTT): Small-for-gestational-age (SGA) Standart deviation (SD) Declarations Ethics approval and consent to participate This retrospective research was carried out in compliance with the Helsinki Declaration. The data were based on clinical records and owing to the retrospective cohort study design this study, so informed consent was not required. Ethical approval was obtained from the ethics committee of the Etlik City Hospital, Ankara, Türkiye Consent for publication Not applicable Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Acknowledgements Not applicable Author contributions Dinçer Sümer design of the work and wrote the main manuscript text Ahmet Arif Filiz, Özge Öztürk and Özgür Volkan Akbulut design of the work and analysis of data Türkan Dikici Aktaş, Mesut Şimşek and Sena Şimşek interpretation of data and drafted the work Zehra Vural Yılmaz reviewed the manuscript Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Gregory EC, Ely DM. 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Diabetes Care. 2010 Mar;33(3):676-82. doi: 10.2337/dc09-1848. PMID: 20190296; PMCID: PMC2827530. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982 Dec 1;144(7):768-73. doi: 10.1016/0002-9378(82)90349-0. PMID: 7148898. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018 Feb;131(2):e49-e64. doi: 10.1097/AOG.0000000000002501. PMID: 29370047. Hod M, Pretty M, Mahmood T; FIGO, EAPM and EBCOG. Joint position statement on universal screening for GDM in Europe by FIGO, EBCOG and EAPM. Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:329-330. doi: 10.1016/j.ejogrb.2018.05.037. Epub 2018 Jun 2. PMID: 29895471. https://www.nice.org.uk/guidance/ng3/chapter/Recommendations/ Access date 30.07.2025 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee; Thompson D, Berger H, Feig D,et al. Diabetes and pregnancy. Can J Diabetes. 2013 Apr;37 Suppl 1:S168-83. doi: 10.1016/j.jcjd.2013.01.044. Epub 2013 Mar 26. PMID: 24070943 Zera CA, Seely EW. Controversies in Gestational Diabetes. touchREV Endocrinol. 2021 Nov;17(2):102-107. doi: 10.17925/EE.2021.17.2.102. Epub 2021 Aug 4. PMID: 35118455; PMCID: PMC8676105. Saccone G, Caissutti C, Khalifeh A, et al. One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials. J Matern Fetal Neonatal Med. 2019 May;32(9):1547-1555. doi: 10.1080/14767058.2017.1408068. Epub 2017 Dec 3. PMID: 29157030. Reddy UM, Abuhamad AZ, Levine D, et al.; Fetal Imaging Workshop Invited Participants*. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol. 2014 May;123(5):1070-1082. doi: 10.1097/AOG.0000000000000245. https://www.who.int/news-room/fact-sheets/detail/preterm-birth Accessed 02 August 2025 Gordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016 Sep;48(3):333-9. doi: 10.1002/uog.15884. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. Society for Maternal-Fetal Medicine (SMFM). Electronic address: [email protected] ; Lee RH, Mara Greenberg, Metz TD, et al.. Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy: Replaces Consult #13, April 2011. Am J Obstet Gynecol. 2021 Feb;224(2):B2-B9. doi: 10.1016/j.ajog.2020.11.002. Epub 2020 Nov 13. PMID: 33197417. Practice Bulletin No 178: Shoulder Dystocia. Obstet Gynecol. 2017 May;129(5):e123-e133. doi: 10.1097/AOG.0000000000002043. PMID: 28426618. Hillier TA, Pedula KL, Ogasawara KK, et al.. A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. N Engl J Med. 2021 Mar 11;384(10):895-904. doi: 10.1056/NEJMoa2026028. PMID: 33704936; PMCID: PMC9041326. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008;32(suppl 1):S1-201 Mayo K, Melamed N, Vandenberghe H, et al. The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol. 2015 Feb;212(2):224.e1-9. doi: 10.1016/j.ajog.2014.08.027. Epub 2014 Aug 27. PMID: 25173183. Lipsombe L, Booth G, Butalia S, et al. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada : Pharmacologic Glycemic Management of Type 2 Diabetes in Adults. Can J Diabetes 2018;42(Suppl 1):S88-S103 Kim MH, Kwak SH, Kim SH, et al. Pregnancy Outcomes of Women Additionally Diagnosed as Gestational Diabetes by the International Association of the Diabetes and Pregnancy Study Groups Criteria. Diabetes Metab J. 2019 Dec;43(6):766-775. doi: 10.4093/dmj.2018.0192. Epub 2019 Feb 28. PMID: 30877713; PMCID: PMC6943275. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7307293","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":504802018,"identity":"2979d6e7-74db-47da-afce-70ee7cc0151a","order_by":0,"name":"Dinçer Sümer","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDCCAwwGBxC8CiBmZm4gRcsZkBZGwloQHMY2MIlfC9/twxsPF9TY5MvPyE58XDmvNpq/HajlR8U2nFokz6UVHJ5xLM1yw43czYZntx3PnXGYsYGx58xtnFoMzvAYHOZtOGxgIJG7TbJx27HcBqAWZsY2glr+G8jPyN3+s3HOsdz5RGo5YMBwI3cbY2NDTe4GQlokz7AVHOY5lmxgcObtZsmGYwdyNwK1HMTnF74zzJs/89TYGci352782FBTlzvv/OGDD35U4NaCDg6DyQNEqweCOlIUj4JRMApGwQgBAClVYT97r9dpAAAAAElFTkSuQmCC","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Dinçer","middleName":"","lastName":"Sümer","suffix":""},{"id":504802021,"identity":"8bce0904-2b5c-4cbe-a8f6-1670a5f0265e","order_by":1,"name":"Ahmet Arif Filiz","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ahmet","middleName":"Arif","lastName":"Filiz","suffix":""},{"id":504802026,"identity":"3241d4f0-6faa-40d6-8d40-2ab4837a461a","order_by":2,"name":"Özge Öztürk","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Özge","middleName":"","lastName":"Öztürk","suffix":""},{"id":504802027,"identity":"e5251649-e674-4170-9b87-8af89b2c5e50","order_by":3,"name":"Türkan Dikici Aktaş","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Türkan","middleName":"Dikici","lastName":"Aktaş","suffix":""},{"id":504802029,"identity":"dfdf713e-3d50-4305-af2d-0b3e077c6593","order_by":4,"name":"Mesut Şimşek","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mesut","middleName":"","lastName":"Şimşek","suffix":""},{"id":504802031,"identity":"372af462-7b45-48dd-97b8-9c6eb74aec3a","order_by":5,"name":"Sena Şimşek","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sena","middleName":"","lastName":"Şimşek","suffix":""},{"id":504802032,"identity":"a8173844-b280-4e07-be8a-4df9aa6cd5bb","order_by":6,"name":"Özgür Volkan Akbulut","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Özgür","middleName":"Volkan","lastName":"Akbulut","suffix":""},{"id":504802035,"identity":"f1e83a91-66d7-4d0b-adae-8a47b55aea45","order_by":7,"name":"Zehra Vural Yılmaz","email":"","orcid":"","institution":"Etlik City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zehra","middleName":"Vural","lastName":"Yılmaz","suffix":""}],"badges":[],"createdAt":"2025-08-06 08:08:42","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7307293/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7307293/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89987915,"identity":"77bdf7bb-ec15-425f-b330-b250c35af7b8","added_by":"auto","created_at":"2025-08-27 07:02:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":324622,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7307293/v1/471a71658e0d17699e819dec.png"},{"id":109295888,"identity":"df806221-d9cd-492d-b8dc-68eb2ba5d74d","added_by":"auto","created_at":"2026-05-15 08:39:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":645946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7307293/v1/80d1938b-df75-427f-b6af-99b44c7495e1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Solely Elevated Fasting Glucose Level In Glucose Tolerance Test: A Dilemma For Diagnosis of GDM","fulltext":[{"header":"Introduction","content":"\u003cp\u003econdition that is associated with significant maternal and fetal adverse outcomes[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Early detection and appropriate treatment of GDM is crucial to minimise perinatal complications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. International guidelines recommend that all pregnant women at increased risk should be screened for gestational diabetes between 24 and 28 weeks' gestation[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. There are two primary approaches to screening and diagnosing GDM. The first is a one-step approach: a 75-gram oral glucose tolerance test (OGTT). According to the criteria of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], GDM is diagnosed when one of the following plasma glucose levels is reached or exceeded: Fasting\u0026thinsp;\u0026ge;\u0026thinsp;92 mg/dL, 1 hour\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dL, or 2 hours\u0026thinsp;\u0026ge;\u0026thinsp;153 mg/dL. The other method is a two-step approach: first, a 50-gram glucose challenge test is performed. If the 1-hour plasma glucose level is \u0026ge;\u0026thinsp;140 mg/dL, a subsequent 100-gram OGTT is recommended. The diagnostic thresholds for the 100-gram OGTT are: Fasting\u0026thinsp;\u0026ge;\u0026thinsp;95 mg/dL, 1 hour\u0026thinsp;\u0026ge;\u0026thinsp;180 mg/dL, 2 hours\u0026thinsp;\u0026ge;\u0026thinsp;155 mg/dL and 3 hours\u0026thinsp;\u0026ge;\u0026thinsp;140 mg/dL. For a diagnosis of GDM, at least two values must meet or exceed these thresholds [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThere is no consensus on the best approach for a diagnostic test for GDM. The American Collage of Obstetric and Gynaecology (ACOG) recommends a two-stage approach, the International Association of Diabetes and Pregnancy Study Groups, the International Federation of Gynaecology and Obstetrics, the World Health Organisation and the National Institute for Health and Care Excellence recommend a one-stage approach,the American Diabetes Association and the Canadian Diabetes Association (CDA) recommend either two approaches to diagnosis [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. And there is also ongoing controversy about these approaches [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. An important discrepancy between these two approaches arises when the fasting blood glucose level is elevated but the postprandial blood glucose level is normal. Solely elevated fasting blood glucose level is a diagnostic criterion for GDM according to the 75 gram OGTT criteria. However, the same fasting blood glucose level determined with the 100-gram OGTT would not receive a GDM diagnosis if there is no elevated postprandial blood glucose level. The main objective of this study is to evaluate and compare the obstetric and neonatal outcomes of pregnant women diagnosed with GDM according to the 75-gram OGTT criteria or not diagnosed with GDM according to the 100-gram OGTT criteria, based on solely elevated fasting glucose levels.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis study planned to be conducted in the perinatology clinic of Etlik City Hospital, Ankara, T\u0026uuml;rkiye. The data were obtained retrospectively from the hospital's electronic medical record system. The study includes pregnant women who underwent a one\u0026ndash;step GTT (75-gram GTT) or a two-step GTT (50-gram glucose load test followed by a 100-gram OGTT) between 24\u0026ndash;32 gestational week, between January 2023 and March 2025 and delivered at the same hospital. The participants were categorised into the following three groups. Patients who were diagnosed with GDM based on solely elevated fasting plasma glucose levels during the 75-gram OGTT were included in Group 1. Patients with solely elevated fasting plasma glucose levels during the 100-gram OGTT who were not diagnosed with GDM were included in Group 2. And patients who were diagnosed with GDM and had otherwise elevated levels during the 75-gram OGTT, except for an solely elevated fasting plasma glucose level, were included in group 3. Multiple pregnancies, patients whom lost for follow up, in whom the OGTT was performed before 23 weeks' gestation, in whom inflammatory disease was present and those taking corticosteroids were excluded from the study. The flow chart of the study is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The local ethics committee approved the study.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn patients diagnosed with GDM on the basis of the OGTT, a two-week diet was recommended and the fasting and postprandial serum glucose values of the first hour were monitored in hospital. The target values were set at 95mg/dL for the fasting value and 140mg/dL for the postprandial value of the first hour. Patients whose glucose levels were below the target values were advised to follow a diet and have their glucose levels reassessed weekly. Patients whose glucose levels were above the target values were recommended insulin therapy. Insulin therapy is individualised and adapted to the advancing gestational age. No diet was recommended for patients with elevated fasting glucose levels in the 100 gram OGTT, but regular reassessment of fasting and postprandial serum glucose levels at two-week intervals was recommended. The target glucose values were determined as GDM-positive patients. Patients whose glucose levels were above the target levels were advised to follow a diet, and if the diet was not yet completed, insulin therapy was recommended.\u003c/p\u003e\u003cp\u003eOligohydramnios is defined as a maximum vertical pocket of less than 2 cm and polyhydramnios is defined as a maximum vertical pocket of 8 cm or more [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].Preterm birth was defined as delivery before 37 weeks' gestation [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Fetal growth restriction (FGR) and small-for-gestational-age (SGA) were defined according to the Delphi consensus [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Gestational hypertension and pre-eclampsia were defined according to the ACOG guideline [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Cholestatis of pregnancy, defined as new-onset pruritis during pregnancy and elevated serum bile acid levels [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Sholderdystocia, defined according to the ACOG guideline [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eThe Statistical Package for the Social Sciences Version 22.0 (IBM Corporation, Armonk, New York, US) was used to analyse the data, with the significance level for the analysis set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The Kolmogrov-Simirnov and Shapiro-Wilk test was used to determine the distribution of the data. The Kruskal-Wallis test, analysis of variance (ANOVA) and the chi-square test or Fisher\u0026rsquo;s exact test were used to compare the groups. The Leneve test was used to determine the homogeneity of variance. The Mann-Whitney U test with Benforri correction and the Tukey test were used for the post-hoc analysis of the numerical data. The chi-square test or Fisher\u0026rsquo;s exact test was used for the post-hoc analysis of categorical data. Median and interquartile ranges (median, IQR) were used for non-normally distributed numerical data. Categorical variables were expressed as frequency and percentage (n,%).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the groups was 31.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59, 29.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26 and 34.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50 respectively(p\u0026thinsp;=\u0026thinsp;0.001), whereby the mean age of group 3 was significantly higher than that of the other groups (group1 vs. group3 p\u0026thinsp;=\u0026thinsp;0.023 and group2 vs. group3 p\u0026thinsp;=\u0026thinsp;0.004). The median number of abortus was 1.0(1.0), 0.0(0.0) and 0.0(1.0) for groups respectively(p\u0026thinsp;=\u0026thinsp;0.013) and group 1 had significantly more abortus than group 2 (group 1 vs. group 2 p\u0026thinsp;=\u0026thinsp;0.002). The demographic characteristics of the groups are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic characteristics of the groups. IQR interquantil range, SD: standart deviation, \u003csup\u003e1\u003c/sup\u003e ANOVA, \u003csup\u003e2\u003c/sup\u003e Kruskal-Wallis test, \u003csup\u003e3\u003c/sup\u003e Fischer\u0026rsquo;s exact test,\u003csup\u003e4\u003c/sup\u003e Tukey test,\u003csup\u003e5\u003c/sup\u003e Mann-Whitney U test with Benforri correction(p\u0026thinsp;\u0026lt;\u0026thinsp;0.016 for significance), \u003csup\u003ea\u003c/sup\u003e Did not calculated\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup 1\u003c/p\u003e\u003cp\u003en:19\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup 2\u003c/p\u003e\u003cp\u003en:17\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup 3\u003c/p\u003e\u003cp\u003en:99\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePost hoc analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup1 vs group2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup1 vs group3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGroup2 vs group3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (year,mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31.26\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.699\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,023\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,004\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGravida (n,median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.0 (4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.138\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.174\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.920\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.045\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParity(n,median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.417\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.973\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.321\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.311\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbortus(n,median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.0(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.013\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.002\u003c/b\u003e\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.112\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.028\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMethod of conception (ın-vitro fertilization, n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(2.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe median week of gestation for the OGTT was 26.0(4.0), 26.0(3.0) and 26.0(2.0) for groups respectively and was not significant (p\u0026thinsp;=\u0026thinsp;0.103). Fasting glucose levels atthe OGTT were 95.0(5.0) mg/dL, 101.0(14.0) mg/dL and 85.0(23.0) mg/dL, respectively, and were significantly different between the groups (p\u0026thinsp;=\u0026thinsp;0.001). All three groups had significantly different fasting glucose levels from each other(p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.001, p\u0026thinsp;=\u0026thinsp;0.001). Twenty-seven (27.3%) patients in group 3 and two (11.8%) patients in group 2 required insulin therapy during follow-up. There were no patients in group 1 who required insulin therapy. The need for insulin therapy was significant for the groups (p\u0026thinsp;=\u0026thinsp;0.025). Significantly more patients required insulin therapy in group 3 than in group 1 (p\u0026thinsp;=\u0026thinsp;0.012). The total number of hospitalisations during pregnancy, total duration of hospitalisation, body mass index (BMI) at birth, weight gain during pregnancy and duration of hospitalisation after birth were not significant for the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The parameters are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParameters of the groups associated with diabetes mellitus. OGTT: Oral Glucose Tolerance Test, BMI: Body Mass Index, \u003csup\u003e1\u003c/sup\u003e Fischer\u0026rsquo;s exact test, \u003csup\u003e2\u003c/sup\u003e Kruskal-Wallis test, \u003csup\u003e3\u003c/sup\u003eMann-Whitney U test, \u003csup\u003e4\u003c/sup\u003eMann-Whitney U test with Benforri correction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.016 for significance), \u003csup\u003ea\u003c/sup\u003e did not calculated.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup1\u003c/p\u003e\u003cp\u003en:19\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup2\u003c/p\u003e\u003cp\u003en:17\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup3\u003c/p\u003e\u003cp\u003en:99\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePost hoc analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup1 vs group2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup1 vs group3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGroup2 vs group3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age at OGTT (week, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26.0(4.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e26.0(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.103\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.858\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.033\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFasting glucose level at OGTT (mg/dL, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95.0(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101.0(14.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e85.0(23.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsuline therapy(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27 (27.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.025\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.216\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.012\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.353\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal number of hospitalization (n, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.119\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.048\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal duration of Hospitalization (day, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.106\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.092\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.660\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.036\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI at birth (kg/m\u003csup\u003e2\u003c/sup\u003e, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.0(6.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33.0(10.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e32.0(8.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.165\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.474\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight gain during pregnancy (kg, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.0(13.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.0(11.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.0(5.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.832\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.645\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.667\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospitalization after birth(day, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.0(1.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.0(0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.313\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.676\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.171\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSeventeen (17.2%) patients in group 3 and 4 (23.5%) patients in group 2 had polyhydramnios. There was no polyhydramnios in group 1. The difference between the groups was significant (p\u0026thinsp;=\u0026thinsp;0.070). The rate of polyhydramnios was similar in group 2 and group 3 and significantly higher than in group 1 (group 1 vs. group 2 p\u0026thinsp;=\u0026thinsp;0.040, group 1 vs. group 3 p\u0026thinsp;=\u0026thinsp;0.071 and group 2 vs. group 3 p\u0026thinsp;=\u0026thinsp;0.507). Two (10.5%) patients in group 1, 1 (5.9%) patient in group 2 and 4 (4.0%) patients in group 3 were found to have a large for gestational age at ultrasound examination during follow-up. The difference between the groups was not significant (p\u0026thinsp;=\u0026thinsp;0.346). Sixteen (84.2%) patients in group 1, 11 (64.7%) patient in group 2 and 80 (80.8%) patients in group 3 underwent caesarean section. The difference between the groups was not significant (p\u0026thinsp;=\u0026thinsp;0.493). There was no intrauterine death or abruptio placenta in the study groups. One patient in group 3 had a sholder dystocia at birth. Oligohydramnios, small for gestational age, fetal growth restriction, preterm labour, gestational hypertension, pre-eclampsia, large for gestational age (LGA), cholestasis of pregnancy were not significant for the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The obstetric outcomes of the groups are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eObstetric outcomes of the groups, \u003csup\u003e1\u003c/sup\u003e Fischer\u0026rsquo;s exact test, \u003csup\u003e2\u003c/sup\u003e Chi-square test, \u003csup\u003ea\u003c/sup\u003e did not calculated.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup1\u003c/p\u003e\u003cp\u003en:19\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup2\u003c/p\u003e\u003cp\u003en:17\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup3\u003c/p\u003e\u003cp\u003en:99\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePost hoc analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGroup1 vs group2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eGroup1 vs group3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eGroup2 vs group3\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePolyhydramnios (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(23.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17(17.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.070\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0,040\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.071\u003c/b\u003e\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.507\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOligohydramnios(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(5.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.595\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmall for gestaional Age (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFetal growth restriction(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.173\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.273\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreterm labour (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(5.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(11.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(14.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.639\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.460\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbruptio placenta(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntra-uterine exitus(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e- \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational Hypertension(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(13.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.299\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.721\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.209\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-eclampsia(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3(15.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3(11.1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.740\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.605\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.697\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.513\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCholestasis of Pregnancy (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge for gestational Age (\u0026gt;\u0026thinsp;4000gram,n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(5.9%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(4.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.346\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.544\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCeasarean Section(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(84.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(64.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e80(80.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.493\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.177\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.310\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSholder dystocia (n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1.0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eGestational age at delivery was 38.0(2.0), 39.0(3.0) and 38.0(2.0) for groups and was not significant (p\u0026thinsp;=\u0026thinsp;0.521). The weight of the newborn was 3229\u0026thinsp;\u0026plusmn;\u0026thinsp;120gr, 3283\u0026thinsp;\u0026plusmn;\u0026thinsp;130gr and 3131\u0026thinsp;\u0026plusmn;\u0026thinsp;63gr for the groups, respectively, and the difference was not significant (p\u0026thinsp;=\u0026thinsp;0.559). The APGAR score at 1 and 5 minutes and the pH of the cord blood sample at birth were not significant for the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The median blood glucose level of the newborn was 69.0(30.3)mg/dL, 66.0(9.0)mg/dL and 61.0(25.0)mg/dL for groups respectively. The difference was statistically significant for the groups (p\u0026thinsp;=\u0026thinsp;0.012). The difference in glucose levels was not significant for group 1 versus group 2 (p\u0026thinsp;=\u0026thinsp;0.295) and group 1 versus group 3 (p\u0026thinsp;=\u0026thinsp;0.124). Group 3 had a significantly lower glucose level than group 2 (group 2 vs. group 3 p\u0026thinsp;=\u0026thinsp;0.006). Two (10.5%) newborns in group 1, 3 (18.8%) in group 2 and 24 (24.2%) in group 3 were admitted to the neonatal intensive care unit (NICU). The hospitalisation rate was not significantly different between the groups (p\u0026thinsp;=\u0026thinsp;0.451). The duration of hospitalisation of the newborn in the NICU was not significantly different between the groups (p\u0026thinsp;=\u0026thinsp;0.572). There was one neonatal death in group 3. A summary of the neonatal outcomes is shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eNeonatal outcome characteristics of the groups, NICU: Neonatal Intensive Care Unit, \u003csup\u003e1\u003c/sup\u003e Fischer\u0026rsquo;s exact test, \u003csup\u003e2\u003c/sup\u003e Kruskal-Wallis test, \u003csup\u003e3\u003c/sup\u003eANOVA, \u003csup\u003e4\u003c/sup\u003eMann-Whitney U test with Benforri correction (p\u0026thinsp;\u0026lt;\u0026thinsp;0.016 for significance)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup1\u003c/p\u003e\u003cp\u003en:19\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup2\u003c/p\u003e\u003cp\u003en:17\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGroup3\u003c/p\u003e\u003cp\u003eN:99\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003ePost hoc analysis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003eGroup1 vs group2\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003eGroup1 vs group3\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003eGroup2 vs group3\u003c/b\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational age at delivery (week, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.0(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.0(2.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.521\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.731\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.443\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.346\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight of the newborn(gram, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3229\u0026thinsp;\u0026plusmn;\u0026thinsp;120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3283\u0026thinsp;\u0026plusmn;\u0026thinsp;130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3131\u0026thinsp;\u0026plusmn;\u0026thinsp;63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.559\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.762\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.526\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.351\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPGAR score 1rd minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.531\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.277\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.426\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.503\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPGAR score 5th minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10(2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10(1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.658\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.513\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.576\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epH level of umblical cord blood at birth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.37(0.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.34(0.14)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.37(0.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.994\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.771\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.933\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.847\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlood glucose level of the newborn (mg/dL, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69.0(30.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.0(9.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.0(25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.012\u003c/b\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.006\u003c/b\u003e\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNICU admission(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2(10.5%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(18.8%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24(24.2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.451\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.642\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuration of hospitalization of the newborn in NICU(day, median,IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.0(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.5(16.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.0(3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.572\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.471\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.507\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeonatal death(n,%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(1%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ep\u0026thinsp;=\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eFasting glucose level was highest in the solely elevated fasting glucose level at 100 g OGTT group(group 2). 11.8% required insulin therapy during follow-up and was comparable to the otherwise positive 75 g OGTT group (group 3). Polyhydramnios, caesarean section and admission of the newborn to the intensive care unit were increased in this group. All patients in solely elevated fasting glucose level at 75 g OGTT (group 1) did not require insulin therapy at follow-up. LGA, gestational hypertension, pre-eclampsia, caesarean section, admission of the newborn to the intensive care unit were increased in this group and comparable to the otherwise positive 75 g OGTT group (group 3). This study shows that solely elevated fasting glucose level is associated with adverse obstetric and neonatal outcomes and these patients should be managed as GDM-positive patients\u003c/p\u003e\u003cp\u003eIn a prospective study, 23792 patients were analysed according to the one- or two-step diagnostic test approach and the obstetric and neonatal outcomes of the two groups were examined and compared. In their study, 16.5% of pregnancies assigned to the 1-step approach and 8.5% of pregnancies assigned to the 2-step approach were diagnosed with GDM. In 39% of 1-step GDM cases, the diagnosis was based on isolated fasting plasma glucose alone, and half of these cases met the criteria by having an isolated fasting plasma glucose in the range of 92\u0026ndash;94 mg/dl [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A total of 1235 patients underwent a one-step diagnostic test for GDM and 15.1% were positive for the test. 13.9% of the overall positive group, the diagnosis was based on solely elevated fasting glucose level, and the median fasting glucose level in this group in our study was 95.0 mg/dl. Among women with GDM, the percentage of women treated with insulin or hypoglycemic medication were similar for the 1-step versus 2-step methods (42.6% and 45.6%, respectively) in their research[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. None of the patients in group 1 required insulin therapy. 27.3% of patients in group 3 required insulin therapy and for patients in group 2 this rate was 11.8% for this study. The incidence of the primary endpoints (LGA, perinatal composite, gestational hypertension/pre-eclampsia and primary caesarean section) did not differ significantly between the groups randomised to the 1-step and 2-step study. It was concluded that despite a doubling of the frequency of GDM diagnosis in the 1-step approach, there were no significant differences between the groups with regard to the risk of any of the primary endpoints [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Polyhydramnios, caesarean section and neonatal ICU admission were increased in all groups and were comparable in our study. Our results show the increased obstetric and neonatal risks for the elevated fasting glucose levels.\u003c/p\u003e\u003cp\u003eIn 2008, the Canadian Diabetes Association (CDA) recommended a 50 gram glucose load test for diabetes screening during pregnancy and a 75 gram OGTT for diagnosis. Two glucose level above the threshold are considered positive criteria for diagnosis and an elevated level is defined as impaired glucose tolerance (IGT) of pregnancy. They mentioned that untreated GDM and IGT have increased and comparable adverse obstetric and neonatal outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A study analysed the IADPSG[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] criteria instead of the CDA[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] criteria for the assessment of GDM and mentioned that this approach would lead to a considerable increase in the rate of GDM, but this also appears to identify additional women at similar risk of adverse pregnancy outcomes [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In 2018, the CDA updated their guideline and suggested a 50 gram glucose load test for screening, followed by a 75 gram OGTT for diagnosis or a one-step 75 gram OGTT. They re-evaluated the IGT of pregnancy and the diagnostic criteria for GDM and an elevated glucose level was established as a positive criterion for the diagnosis of GDM[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our results show increased and comparable obstetric and neonatal outcomes for solely elevated fasting glucose level in both the 75 g OGTT and the 100 g OGTT with GDM and are consistent with CDA's diagnostic assessment for GDM.\u003c/p\u003e\u003cp\u003eThe obstetric and neonatal outcomes of 2038 patients were analysed and compared in a prospective study. 50 gr glucose challenge test followed by 75 gr OGTT performed to diagnose GDM. IADPSG criteria (one or more abnormal values) and Carpenter and Coustan (CC) criteria (two or more abnormal values), but not the postprandial 3rd hour, were used for diagnosis. Patients were divided into three groups. The non-GDM group did not fulfil either the IADPSG or CC criteria, the GDM group was based on the IADPSG criteria but not the CC criteria, and the GDM group was based on the CC criteria. They mentioned that the IADPSG criteria increased the incidence of GDM diagnosis threefold and the IADPSG-based GDM group had significantly higher pre-eclampsia, phototherapy and overall adverse outcomes than the CC-based GDM group [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Rates of gestational hypertension, pre-eclampsia, LGA and caesarean section were not significantly higher in group 1 than in group 2. Polyhydramnios was significantly more common in group 2 than in group 1. Requirement for insulin therapy, polyhydramnios, preterm labour, LGA, caesarean section, admission of the newborn to the ICU and duration of ICU admission were comparable between group 2 and group 3. Our results confirm this research and show the increased and comparable risk for solely elevated fasting glucose level, but not diagnosed and managed as GDM, detected on a 100 gram OGTT.\u003c/p\u003e"},{"header":"Strengths","content":"\u003cp\u003eOne of the major strengths of this study is the use of data from a large tertiary care centre, which increases the generalisability of the results. The study fills a significant gap in the literature by directly comparing maternal and neonatal outcomes in pregnancies with solely elevated fasting blood glucose on both 75-gram and 100-gram OGTTs. By categorising patients into three distinct groups based on the diagnostic thresholds of different guidelines, this study provides a nuanced analysis of the clinical impact of fasting hyperglycaemia in pregnancy. In addition, the use of uniform diagnostic criteria, comprehensive follow-up and a standardised treatment algorithm strengthens the internal validity of the results.\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study has several limitations. First, the retrospective design harbours the possibility of selection bias and limits control over confounding variables. Second, the sample size, particularly in groups 1 and 2, was relatively small, which may have limited the power to detect certain statistically significant differences. In addition, the lack of long-term follow-up data for both mothers and newborns limits the assessment of long-term metabolic outcomes. Another limitation is the reliance on a single fasting glucose measurement during the OGTT, which may be subject to biological variation. Finally, the study was conducted in a single centre in T\u0026uuml;rkiye, so external validity to other populations or health systems may be limited.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study shows that an isolated elevated fasting glucose level, regardless of the OGTT method, is associated with increased maternal and neonatal complications. These findings support managing such cases as GDM, even if the current two-step diagnostic criteria are not met. Reviewing the diagnostic thresholds and adjusting clinical treatment protocols accordingly may improve pregnancy outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAmerican Collage of Obstetric and Gynecology(ACOG)\u003c/p\u003e\n\u003cp\u003eAnalysis of Variance (ANOVA)\u003c/p\u003e\n\u003cp\u003eBody Mass Index(BMI)\u003c/p\u003e\n\u003cp\u003eCanadian Diabetes Association(CDA)\u003c/p\u003e\n\u003cp\u003eCarpenter and Coustan (CC)\u003c/p\u003e\n\u003cp\u003eFetal growth restriction (FGR)\u003c/p\u003e\n\u003cp\u003eGestational diabetes mellitus (GDM)\u003c/p\u003e\n\u003cp\u003eInternational Association of Diabetes and Pregnancy Study Groups (IADPSG)\u003c/p\u003e\n\u003cp\u003eInterquartile ranges (IQR)\u003c/p\u003e\n\u003cp\u003eLarge for gestational age (LGA),\u003c/p\u003e\n\u003cp\u003eNeonatal Intensive Care Unite (NICU).\u003c/p\u003e\n\u003cp\u003eOral glucose tolerance test (OGTT):\u003c/p\u003e\n\u003cp\u003eSmall-for-gestational-age (SGA)\u003c/p\u003e\n\u003cp\u003eStandart deviation (SD)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003eThis retrospective research was carried out in compliance with the Helsinki Declaration. The data were based on clinical records and owing to the retrospective cohort study design this study, so informed consent was not required. Ethical approval was obtained from the ethics committee of the\u0026nbsp;Etlik City Hospital, Ankara, T\u0026uuml;rkiye\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDin\u0026ccedil;er S\u0026uuml;mer design of the work and wrote the main manuscript text\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAhmet Arif Filiz, \u0026Ouml;zge \u0026Ouml;zt\u0026uuml;rk \u0026nbsp;and \u0026Ouml;zg\u0026uuml;r Volkan Akbulut design of the work and analysis of data\u003c/p\u003e\n\u003cp\u003eT\u0026uuml;rkan Dikici Aktaş, Mesut Şimşek and Sena Şimşek interpretation of data and drafted the work\u003c/p\u003e\n\u003cp\u003eZehra Vural Yılmaz \u0026nbsp;reviewed the manuscript\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eFunding\u003c/strong\u003e This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGregory EC, Ely DM. Trends and Characteristics in Gestational Diabetes: United States, 2016-2020. Natl Vital Stat Rep. 2022 Jul;71(3):1-15. PMID: 35877134.\u003c/li\u003e\n\u003cli\u003eBilous RW, Jacklin PB, Maresh MJ, et al. Resolving the Gestational Diabetes Diagnosis Conundrum: The Need for a Randomized Controlled Trial of Treatment. Diabetes Care. 2021 Apr;44(4):858-864. doi: 10.2337/dc20-2941. PMID: 33741696; PMCID: PMC8578931.\u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association. (2024). \u003cem\u003eStandards of Medical Care in Diabetes\u0026mdash;2024.\u003c/em\u003e Diabetes Care, 47(Supplement_1), S1\u0026ndash;S300. https://doi.org/10.2337/dc24-S001\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. (2013). \u003cem\u003eDiagnostic criteria and classification of hyperglycaemia first detected in pregnancy\u003c/em\u003e. WHO Guidelines.\u003c/li\u003e\n\u003cli\u003eInternational Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676-82. doi: 10.2337/dc09-1848. PMID: 20190296; PMCID: PMC2827530.\u003c/li\u003e\n\u003cli\u003eCarpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982 Dec 1;144(7):768-73. doi: 10.1016/0002-9378(82)90349-0. PMID: 7148898.\u003c/li\u003e\n\u003cli\u003eACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018 Feb;131(2):e49-e64. doi: 10.1097/AOG.0000000000002501. PMID: 29370047.\u003c/li\u003e\n\u003cli\u003eHod M, Pretty M, Mahmood T; FIGO, EAPM and EBCOG. Joint position statement on universal screening for GDM in Europe by FIGO, EBCOG and EAPM. Eur J Obstet Gynecol Reprod Biol. 2018 Sep;228:329-330. doi: 10.1016/j.ejogrb.2018.05.037. Epub 2018 Jun 2. PMID: 29895471.\u003c/li\u003e\n\u003cli\u003ehttps://www.nice.org.uk/guidance/ng3/chapter/Recommendations/ Access date 30.07.2025\u003c/li\u003e\n\u003cli\u003eCanadian Diabetes Association Clinical Practice Guidelines Expert Committee; Thompson D, Berger H, Feig D,et al. Diabetes and pregnancy. Can J Diabetes. 2013 Apr;37 Suppl 1:S168-83. doi: 10.1016/j.jcjd.2013.01.044. Epub 2013 Mar 26. PMID: 24070943\u003c/li\u003e\n\u003cli\u003eZera CA, Seely EW. Controversies in Gestational Diabetes. touchREV Endocrinol. 2021 Nov;17(2):102-107. doi: 10.17925/EE.2021.17.2.102. Epub 2021 Aug 4. PMID: 35118455; PMCID: PMC8676105.\u003c/li\u003e\n\u003cli\u003eSaccone G, Caissutti C, Khalifeh A, et al. One step versus two step approach for gestational diabetes screening: systematic review and meta-analysis of the randomized trials. J Matern Fetal Neonatal Med. 2019 May;32(9):1547-1555. doi: 10.1080/14767058.2017.1408068. Epub 2017 Dec 3. PMID: 29157030.\u003c/li\u003e\n\u003cli\u003eReddy UM, Abuhamad AZ, Levine D, et al.; Fetal Imaging Workshop Invited Participants*. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging workshop. Obstet Gynecol. 2014 May;123(5):1070-1082. doi: 10.1097/AOG.0000000000000245.\u003c/li\u003e\n\u003cli\u003ehttps://www.who.int/news-room/fact-sheets/detail/preterm-birth Accessed 02 August 2025\u003c/li\u003e\n\u003cli\u003eGordijn SJ, Beune IM, Thilaganathan B, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016 Sep;48(3):333-9. doi: 10.1002/uog.15884. \u003c/li\u003e\n\u003cli\u003eGestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. \u003c/li\u003e\n\u003cli\u003eSociety for Maternal-Fetal Medicine (SMFM). Electronic address: [email protected]; Lee RH, Mara Greenberg, Metz TD, et al.. Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy: Replaces Consult #13, April 2011. Am J Obstet Gynecol. 2021 Feb;224(2):B2-B9. doi: 10.1016/j.ajog.2020.11.002. Epub 2020 Nov 13. PMID: 33197417.\u003c/li\u003e\n\u003cli\u003ePractice Bulletin No 178: Shoulder Dystocia. Obstet Gynecol. 2017 May;129(5):e123-e133. doi: 10.1097/AOG.0000000000002043. PMID: 28426618.\u003c/li\u003e\n\u003cli\u003eHillier TA, Pedula KL, Ogasawara KK, et al.. A Pragmatic, Randomized Clinical Trial of Gestational Diabetes Screening. N Engl J Med. 2021 Mar 11;384(10):895-904. doi: 10.1056/NEJMoa2026028. PMID: 33704936; PMCID: PMC9041326.\u003c/li\u003e\n\u003cli\u003eCanadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008;32(suppl 1):S1-201\u003c/li\u003e\n\u003cli\u003eMayo K, Melamed N, Vandenberghe H, et al. The impact of adoption of the international association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational diabetes. Am J Obstet Gynecol. 2015 Feb;212(2):224.e1-9. doi: 10.1016/j.ajog.2014.08.027. Epub 2014 Aug 27. PMID: 25173183.\u003c/li\u003e\n\u003cli\u003eLipsombe L, Booth G, Butalia S, et al. \u003cem\u003eDiabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada\u003c/em\u003e: Pharmacologic Glycemic Management of Type 2 Diabetes in Adults. Can J Diabetes 2018;42(Suppl 1):S88-S103\u003c/li\u003e\n\u003cli\u003eKim MH, Kwak SH, Kim SH, et al. Pregnancy Outcomes of Women Additionally Diagnosed as Gestational Diabetes by the International Association of the Diabetes and Pregnancy Study Groups Criteria. Diabetes Metab J. 2019 Dec;43(6):766-775. doi: 10.4093/dmj.2018.0192. Epub 2019 Feb 28. PMID: 30877713; PMCID: PMC6943275.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gestational diabetes mellitus, fasting glucose, OGTT, one-step approach, two-step approach, obstetric outcomes, neonatal outcomes","lastPublishedDoi":"10.21203/rs.3.rs-7307293/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7307293/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo evaluate and compare obstetric and neonatal outcomes of pregnant women with solely elevated fasting glucose levels who were diagnosed with gestational diabetes mellitus (GDM) using the 75-gram OGTT approach with those who were not diagnosed with GDM using the 100-gram OGTT approach.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis retrospective study was conducted at Etlik City Hospital, Ankara, T\u0026uuml;rkiye, and included pregnant women who underwent either a 75-gram or a 100-gram OGTT between January 2023 and March 2025 between 24 and 32 weeks of gestation. The participants were categorized into three groups: Group 1; with a diagnosis of GDM based on solely elevated fasting blood glucose during the 75-gram OGTT. Group 2; not diagnosed with GDM despite elevated fasting glucose during the 100-gram OGTT. Group 3; diagnosed with GDM due to an otherwise positive value in the 75-gram OGTT approach except for the solely fasting glucose level. Obstetric and neonatal outcomes, diabetes parameters, insulin therapy requirement,and birth characteristics were analysed and compared between groups.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eFasting glucose levels were significantly higher in group 2 compared to the other groups (p\u0026thinsp;=\u0026thinsp;0.001). No patient in group 1 required insulin, while 11.8% of group 2 and 27.3% of group 3 required insulin therapy (p\u0026thinsp;=\u0026thinsp;0.025). Neonatal blood glucose levels were significantly lower in group 3 compared to group 2 (p\u0026thinsp;=\u0026thinsp;0.006). Requirement for insulin therapy, polyhydramnios, preterm birth, LGA, caesarean section, admission of the newborn to the intensive care unit and the duration of admission to the intensive care unit were comparable between group 2 and group 3.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eSolely elevated fasting glucose levels, at diagnostic test for GDM, are associated with adverse obstetric and neonatal outcomes. These findings support the inclusion of solely elevated fasting glucose level as a diagnostic criterion for GDM and point to the need for standardised treatment of these patients, regardless of the OGTT method used.\u003c/p\u003e","manuscriptTitle":"Solely Elevated Fasting Glucose Level In Glucose Tolerance Test: A Dilemma For Diagnosis of GDM","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-27 07:02:15","doi":"10.21203/rs.3.rs-7307293/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"07824157-ed15-436e-8a00-8089ffd8649f","owner":[],"postedDate":"August 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-11T18:10:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-27 07:02:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7307293","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7307293","identity":"rs-7307293","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}