Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes

Val, T. López del; Lázaro, Victoria Alcázar; Lacalle, Concepción García; Moreno, Beatriz Torres; Carbajal, Gabriela Castillo; Fernández, Beatriz

doi:10.1016/j.endien.2019.01.001

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…Of note, the study excluded women with an FPG of more than 105 mg/dL (5.8 mmol/L) [ 33 ]. Several other studies have shown an association between LGA and macrosomia with elevation in first-trimester FPG [ 36 , 41 , 46 , 47 , 48 , 49 ]. A higher FPG was also associated with pregnancy-induced hypertension (PIH) [ 36 , 46 , 48 ], prematurity and preterm birth [ 46 , 48 ], non-evolutive pregnancies and fetal death [ 50 ], CS and assisted vaginal delivery [ 41 ], and neonatal intensive care unit (NICU) admission [ 51 ].…”

Section: Fasting Plasma Glucose For Diagnosis Of Egdmmentioning

confidence: 99%

“…First-trimester FPG ≥ 92 mg/dL (5.1 mmol/L), as well as 100.8 mg/dL (5.6 mmol/L), indicate a higher risk of macrosomia, LGA, non-evolutive pregnancies, fetal death, PIH, and NICU admissions [ 36 , 48 , 49 , 50 , 51 ]. In a recently published large retrospective study analyzing 22,398 singleton pregnancies, FPG ≥ 92 mg/dL (5.1 mmol/L) and a normal OGTT between 24 and 28 weeks had a similar pregnancy outcome as cGDM [ 48 ].…”

Section: Fasting Plasma Glucose For Diagnosis Of Egdmmentioning

confidence: 99%

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Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

et al. 2021

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Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.

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Section: Fasting Plasma Glucose For Diagnosis Of Egdmmentioning

confidence: 99%

Section: Fasting Plasma Glucose For Diagnosis Of Egdmmentioning

confidence: 99%

Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

et al. 2021

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“…However, with limited trial data and by extrapolating results from the HAPO study conducted during the second trimester to early gestation, IADPSG has endorsed the diagnostic criteria of GDM for fasting plasma glucose (FPG) in the range of 5.1-6.9 mmol/l (1). Nevertheless, emerging data has challenged this recommendation since many such women no longer meet the criteria for GDM when later rescreened during the second trimester of pregnancy (8)(9)(10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter?

et al. 2023

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ObjectivesThe aim of the study was to investigate the effect of treatment on pregnancy outcomes among women who had fasting plasma glucose (FPG) 5.1-5.6 mmol/l in the first trimester of pregnancy.MethodsWe performed a secondary-analysis of a randomized community non-inferiority trial of gestational diabetes mellitus (GDM) screening. All pregnant women with FPG values range 5.1-5.6 mmol/l in the first trimester of gestation were included in the present study (n=3297) and classified to either the (i) intervention group who received treatment for GDM along with usual prenatal care (n=1,198), (ii) control group who received usual-prenatal-care (n=2,099). Macrosomia/large for gestational age (LGA) and primary cesarean-section (C-S) were considered as primary-outcomes. A modified-Poisson-regression for binary outcome data with a log link function and robust error variance was used to RR (95%CI) for the associations between GDM status and incidence of pregnancy outcomes.ResultsThe mean maternal age and BMI of pregnant women in both study groups were similar. There were no statistically significant differences in the adjusted risks of adverse pregnancy outcomes, including macrosomia, primary C-S, preterm birth, hyperbilirubinemia, preeclampsia, NICU-admission, birth trauma, and LBW both groups.ConclusionsIt is found that treating women with first-trimester FPG values of 5.1-5.6 mmol/l could not improve adverse pregnancy outcomes including macrosomia, Primary C-S, Preterm birth, hypoglycemia, hypocalcemia, preeclampsia, NICU admission, Birth trauma and LBW. Therefore, extrapolating the FPG cut-off point of the second trimester to the first –which has been proposed by the IADPSG, might therefore not be appropriate.Clinical Trial Registrationhttps://www.irct.ir/trial/518, identifier IRCT138707081281N1.

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“…Quando avaliamos as gestantes com DMG de acordo com o método diagnóstico, por glicemia de jejum ou por TTOG, observamos que o primeiro grupo apresentou maior IMC pré-gestacional, maior frequência de uso de insulina, de RN GIGs e de alterações no TTOG pós parto; este dado é compatível com achados da literatura (85)(86)(87) , que mostram um perfil diferente deste subgrupo, apresentando maior gravidade e repercussão materno fetal, provavelmente associado a uma maior resistência hepática à insulina deste grupo (72) .…”

Section: Achados Clínicos E Laboratoriaisunclassified

“…Apesar da presença do alelo C dos SNPs rs10068521 e rs9292578 no gene PRLR terem sido associadas ao DMG em um estudo chileno (31) , este achado não foi reproduzido no presente estudo. Essa discordância poderia ser explicada por razões étnicas ou pela diferença no critério diagnóstico usada; no presente estudo, usamos o critério do IADPSG (GJA no primeiro trimestre (85) (31,(94)(95)(96)(97) .…”

Section: Osunclassified

O polimorfismo de um único nucleotídeo rs17619600 no gene HTR2B modula a suscetibilidade ao diabetes mellitus gestacional

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Aos pacientes que participaram da pesquisa.À minha orientadora Dra. Maria Lúcia Cardillo Corrêa Giannella (Dra. Malu), agradeço por ter acreditado no meu sonho e me apoiado nessa jornada.Muito obrigada por ter aguentado todas as minhas inseguranças, minhas três gestações, a pandemia ... você sempre com palavras de calma e apoio, mostrando que conseguiríamos fazer tudo, sempre tão positiva, mostrando os caminhos que muitas vezes eu não conseguia ver. Obrigada por ser tão compreensiva e paciente com as minhas ansiedades.Agradeço à minha coorientadora, Rossana Pulcineli Vieira Francisco, por acreditar no nosso projeto, por me abrir as portas da Obstetrícia, por me acolher tão bem, quantos ensinamentos nessa área ao longo desses anos.Agradeço ao acolhimento que recebi da Obstetrícia, começando pela Lucinda Cristina Pereira, com a sua infinita gentileza, sempre tão disponível e pronta a ajudar. A enfermeira Ana Maria Sousa, com seu enorme sorriso me ajudou nas coletas dos pacientes, não conseguiria sem sua ajuda.Agradeço aos residentes e preceptores da Obstetrícia que acompanhavam os atendimentos das pacientes do estudo.

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Fasting glucose in the first trimester: An initial approach to diagnosis of gestational diabetes

Cited by 4 publications

References 22 publications

Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

Does fasting plasma glucose values 5.1-5.6 mmol/l in the first trimester of gestation a matter?

O polimorfismo de um único nucleotídeo rs17619600 no gene HTR2B modula a suscetibilidade ao diabetes mellitus gestacional

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