The HAPO study established which primary relationship in gestational diabetes?
- A A single blood glucose threshold that separates safe from unsafe outcomes
- B A continuous linear relationship between maternal glucose levels and adverse outcomes including macrosomia and cord C-peptide ✓
- C That maternal glucose levels above 7.8 mmol/L at 2 hours cause significant neonatal hypoglycemia
- D That first-trimester glucose screening is superior to 75g OGTT at 24–28 weeks
Correct answer: B. A continuous linear relationship between maternal glucose levels and adverse outcomes including macrosomia and cord C-peptide
Explanation
The HAPO study (Hyperglycemia and Adverse Pregnancy Outcomes, NEJM 2008) demonstrated a continuous, graded, linear association between maternal glucose levels (at fasting, 1-hour, and 2-hour time points on 75g OGTT) and adverse outcomes including birth weight >90th percentile, primary cesarean delivery, neonatal hypoglycemia, and cord C-peptide >90th percentile. There was no clear threshold; risk rose across the entire glucose range, which led to the IADPSG 2010 diagnostic criteria for GDM based on ORs of 1.75 for these outcomes.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.