Fasting plasma glucose in the first trimester is related to gestational diabetes mellitus and adverse pregnancy outcomes

Abstract

Purpose To investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population. Methods We used data of 48,444 pregnant women that had been retrospectively collected between 2017 and 2019. Logistic regression analysis was used to evaluated the associations between first-trimester FPG and GDM and adverse pregnancy outcomes, and used to construct a nomogram model for predicting the risk of GDM. The performance of the nomogram was evaluated by using ROC and calibration curves. Decision curve analysis (DCA) was used to determine the clinical usefulness of the first-trimester FPG by quantifying the net benefits at different threshold probabilities. Results The mean first-trimester FPG was 4.62 ± 0.42 mmol/L. A total of 6998 (14.4%) pregnancies developed GDM.489(1.01%) pregnancies developed polyhydramnios, the prevalence rates of gestational hypertensive disorder (GHD), cesarean section, primary cesarean section, preterm delivery before 37 weeks (PD) and dystocia was 1130 (2.33%), 20,426 (42.16%), 7237 (14.94%), 2386 (4.93%), and 1865 (3.85%), respectively. 4233 (8.74%) of the newborns were LGA, and the number of macrosomia was 2272 (4.69%), LBW was 1701 (3.51%) and 5084 (10.49%) newborns had admission to the ICU, which all showed significances between GDM and non-GDM groups (all P < 0.05). The univariate analysis showed that first-trimester FPG was strongly associated with risks of outcomes including GDM, cesarean section, macrosomia, GHD, primary cesarean section, and LGA (all OR > 1, all P < 0.05), furthermore, the risks of GDM, primary cesarean section, and LGA was increasing with first-trimester FPG as early as it was at 4.19–4.63 mmol/L. The multivariable analysis showed that the risks of GDM (ORs for FPG 4.19–4.63, 4.63–5.11 and 5.11–7.0 mmol/L were 1.137, 1.592, and 4.031, respectively, all P < 0.05) increased as early as first-trimester FPG was at 4.19–4.63 mmol/L, and first-trimester FPG which was also associated with the risks of cesarean section, macrosomia and LGA (OR for FPG 5.11–7.0 mmol/L of cesarean section: 1.128; OR for FPG 5.11–7.0 mmol/L of macrosomia: 1.561; OR for FPG 4.63–5.11 and 5.11–7.0 mmol/L of LGA: 1.149 and 1.426, respectively, all P < 0.05) and with its increasing, the risks of LGA increased. Furthermore, the nomogram had a C-indices 0.771(95% CI: 0.763~0.779) and 0.770(95% CI:0.758~0.781) in training and testing validation respectively, which showed an acceptable consistency between the observed, validation and nomogram-predicted probabilities, the DAC curve analysis indicated that the nomogram had important clinical application value for GDM risk prediction. Conclusions FPG in the first trimester was an independent risk factor for GDM which can be used as a screening test for identifying pregnancies at risk of GDM and adverse pregnancy outcomes.

Update on gestational diabetes and adverse pregnancy outcomes

“…Fasting glucose in the first trimester has been strongly correlated with risk of giving birth to large babies, with the results from Tong et al in 2022 showing it to be an independent risk factor. The study found that a fasting glucose between 5.1 and 7 mmol/l increased the ORs of both LGA (OR 1.426, P < 0.05) and macrosomia (OR 1.56, P < 0.05), and was in keeping with the HAPO study in 2008 [27].…”

“…Three studies from the included articles reported similar OR in lower region [14,16], with Tong et al in 2022 study reported a strong link between fasting plasma glucose in the first trimester and the risk of APO. They reported an increased ORs of caesarean section if the plasma glucose levels were between 5.1 and 7.0 mmol/l (OR 1.128, 95% CI 1.025–1.241) [27], which is in line with the findings from the HAPO study. In addition, Olerich et al [28] in 2022 was able to demonstrate that even after adjusting for singleton and cephalic pregnancies at term with no previous history of caesarean section, the increased ORs of caesarean section was preserved (OR 1.37, 95% CI 1.29–1.45).…”

Early pregnancy hyperglycaemia as a significant predictor of large for gestational age neonates

“…The HAPO study showed that there is a significant association between GDM/HIP in the second and third trimesters and having an LGA neonate [ 10 ]. Many recent retrospective studies using secondary data or electronic databases in Israel [ 21 ], Australia [ 34 ], China [ 11 , 35 , 36 ], Spain [ 16 ] and other places have shown that this observation is valid for T1 as well. The systematic review and meta-analysis by Farrar et al [ 37 ] showed a graded linear association between glucose concentration and adverse perinatal outcomes, including LGA neonates.…”

Gut Microbiota-Derived Short Chain Fatty Acids Are Associated with Clinical Pregnancy Outcome in Women Undergoing IVF/ICSI-ET: A Retrospective Study

“…Considering circulating biomarkers of cardiometabolic health such as HOMA-IR, TG and low-density lipoprotein (LDL) are also related to the diet structure [17][18][19], suggesting that fecal propionate might play the mediator role in dietary intake and in those markers of glycolipid metabolism. Previous studies have certified that elevated FSI and TG levels in early pregnancy were associated with adverse pregnancy outcomes, such as gestational diabetes mellitus and large-for-gestational-age, and can be used as reliable markers of adverse pregnancy outcomes [20][21][22]. It has been suggested that hyperglycemia affects embryonic development and increases the vulnerability of embryos to cardiac malformations [23].…”