Prognosis associated with initial care of increased fasting glucose in early pregnancy: A retrospective study

• Published in: Diabetes & metabolism Vol. 47; no. 3; p. 101197
• Main Authors: Cosson, E., Vicaut, E., Berkane, N., Cianganu, T.L., Baudry, C., Portal, J.-J., Boujenah, J., Valensi, P., Carbillon, L.
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-05-2021; Elsevier Masson
• Subjects: Blood Glucose - metabolism; Diabetes, Gestational - therapy; Early screening; Fasting - blood; Female; Food and Nutrition; Gestational diabetes mellitus; Gynecology and obstetrics; Human health and pathology; Humans; Hyperglycemia - therapy; Life Sciences; Pregnancy; Pregnancy Outcome; Prognosis; Retrospective Studies; RCT; Prognosis; LGA; IPTW; Gestational diabetes mellitus; Early screening; FIGO; WG; GDM; FPG; OGTT; IADPSG; BMI; WHO
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2020.08.007

To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1–6.9mmol/L before 22 weeks of gestation (WG), termed ‘early fasting hyperglycaemia’, is associated with fewer adverse outcomes than no initial care.
A total of 523 women with early fasting hyperglycaemia were retrospectively selected in our department (2012–2016) and separated into two groups: (i) those who received immediate care (n=255); and (ii) those who did not (n=268), but had an oral glucose tolerance test (OGTT) at or after 22 WG, with subsequent standard care if hyperglycaemia (by WHO criteria) was present. The number of cases of large-for-gestational age (LGA) infants, shoulder dystocia and preeclampsia with initial care of early fasting hyperglycaemia were compared after propensity score modelling and accounting for covariates.
Of the 268 women with no initial care, 134 had hyperglycaemia after 22 WG and then received care. Women who received initial care vs those who did not were more likely to be insulin-treated during pregnancy (58.0% vs 20.9%, respectively; P<0.00001), gained less gestational weight (8.6±5.4kg vs 10.8±6.1kg, respectively; P<0.00001), had a lower rate of preeclampsia [1.2% vs 2.6%, respectively; adjusted odds ratio (aOR): 0.247 (0.082–0.759), P=0.01], and similar rates of LGA infants (12.2% vs 11.9%, respectively) and shoulder dystocia (1.6% vs 1.5%, respectively). When initial FPG levels were ≥5.5mmol/L (prespecified group, n=137), there was a lower rate of LGA infants [6.7% vs 16.1%, respectively; aOR: 0.332 (0.122–0.898); P=0.03].
Treating women with early fasting hyperglycaemia, especially when FPG is ≥5.5mmol/L, may improve pregnancy outcomes, although this now needs to be confirmed by randomized clinical trials.