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

Cosson, E.; Vicaut, Éric; Berkane, Narimane; Cianganu, T.L.; Baudry, Camille; Portal, Jean-Jacques; Boujenah, J.; Valensi, P.; Carbillon, Lionel

doi:10.1016/j.diabet.2020.08.007

Cited by 13 publications

(18 citation statements)

References 35 publications

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“…Riskin-Mashiah et al studied a large number of pregnant women from Israel (n=6129) and obtained similar results to ours, namely, that rst-trimester FPG has an independent relationship with the risks of GDM and LGA [5]. In addition, studies of lifestyle interventions to prevent GDM have shown that it works best in the early stages of pregnancy [13][14].…”

Section: Discussionsupporting

confidence: 81%

Fasting plasma glucose in the first trimester is related to Gestational Diabetes Mellitus and adverse pregnancy outcomes

Tong

Chen

et al. 2021

Preprint

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PurposeTo investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population.MethodsWe 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.ResultsThe 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%), 20426(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.ConclusionsFPG 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.

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Section: Discussionsupporting

confidence: 81%

Fasting plasma glucose in the first trimester is related to Gestational Diabetes Mellitus and adverse pregnancy outcomes

Tong

Chen

et al. 2021

Preprint

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“…In general, most studies show that women with early GDM are at high risk for adverse pregnancy outcomes but treatment of GDM early in pregnancy compared to later in pregnancy does not always translate into improved outcomes. Seven studies reported an improved pregnancy outcome by treatment of early-onset GDM [ 7 , 9 , 10 , 29 , 30 , 31 , 34 ]. Barahona et al [ 9 ] showed that diagnosing GDM early in pregnancy is a predictor of adverse maternal and neonatal outcomes, such as pregnancy-induced hypertension, insulin treatment during pregnancy, preterm birth, hyperbilirubinemia and perinatal mortality.…”

Section: Resultsmentioning

confidence: 99%

“…Barahona et al [ 9 ] showed that diagnosing GDM early in pregnancy is a predictor of adverse maternal and neonatal outcomes, such as pregnancy-induced hypertension, insulin treatment during pregnancy, preterm birth, hyperbilirubinemia and perinatal mortality. More recently, Cosson et al [ 31 ] reported that 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 ± 5.4 kg vs. 10.8 ± 6.1 kg, 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 and shoulder dystocia. A very recent study from Thailand showed that early GDM women had a high risk for adverse pregnancy outcomes with higher rates of preeclampsia, LGA infants, and NICU admission [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of all observational studies ( Table 1 ), 15 studies discussed the diagnostic criteria for GDM early in pregnancy [ 11 , 12 , 13 , 14 , 16 , 18 , 21 , 24 , 26 , 27 , 28 , 31 , 32 , 35 , 36 ]. Riskin et al showed that first trimester fasting glucose levels (FTFPG) in the non-diabetic range resulted in a higher risk for adverse pregnancy outcomes, such as more cesarian sections, LGA and macrosomia.…”

Section: Resultsmentioning

confidence: 99%

“…A Belgium study [ 28 ] for instance demonstrated that only 37% of all women with an FTFPG ≥ 5.1–5.5 mmol/L, developed GDM based on the OGTT later in pregnancy. A French study proposed to use an FTFPG ≥ 5.5 mmol/L to start treatment for GDM in early pregnancy, as they demonstrated improved pregnancy outcomes in their population [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

Raets

Beunen

Benhalima

2021

JCM

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The incidence of gestational diabetes mellitus (GDM) is increasing worldwide. This has a significant effect on the health of the mother and offspring. There is no doubt that screening for GDM between 24 and 28 weeks is important to reduce the risk of adverse pregnancy outcomes. However, there is no consensus about diagnosis and treatment of GDM in early pregnancy. In this narrative review on the current evidence on screening for GDM in early pregnancy, we included 37 cohort studies and eight randomized controlled trials (RCTs). Observational studies have shown that a high proportion (15–70%) of women with GDM can be detected early in pregnancy depending on the setting, criteria used and screening strategy. Data from observational studies on the potential benefit of screening and treatment of GDM in early pregnancy show conflicting results. In addition, there is substantial heterogeneity in age and BMI across the different study populations. Smaller RCTs could not show benefit but several large RCTs are ongoing. RCTs are also necessary to determine the appropriate cut-off for HbA1c in pregnancy as there is limited evidence showing that an HbA1c ≥6.5% has a low sensitivity to detect overt diabetes in early pregnancy.

show abstract

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

Tong

Chen

et al. 2021

Endocrine

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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.

show abstract

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

Cited by 13 publications

References 35 publications

Fasting plasma glucose in the first trimester is related to Gestational Diabetes Mellitus and adverse pregnancy outcomes

Fasting plasma glucose in the first trimester is related to Gestational Diabetes Mellitus and adverse pregnancy outcomes

Screening for Gestational Diabetes Mellitus in Early Pregnancy: What Is the Evidence?

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

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