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

Suneth Buddhika Agampodi,Iresha Sandamali Koralegedara,Imasha Upulini Jayasinghe

doi:10.1007/s00592-021-01828-1

Suneth Buddhika Agampodi, Iresha Sandamali Koralegedara

Open Access

https://doi.org/10.1007/s00592-021-01828-1

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Journal: Acta Diabetologica	Publication Date: Jan 1, 2022
Citations: 6	License type: open-access

Affiliation: Rajarata University of Sri Lanka

Abstract

AimsWe aimed to determine the effect of early pregnancy hyperglycaemia on having a large for gestational age (LGA) neonate.MethodsA prospective cohort study was conducted among pregnant women in their first trimester. One-step plasma glucose (PG) evaluation procedure was performed to assess gestational diabetes mellitus (GDM) and diabetes mellitus (DM) in pregnancy as defined by the World Health Organization (WHO) criteria with International Association of Diabetes in Pregnancy Study Group (IADPSG) thresholds. The main outcome studied was large for gestational age neonates (LGA).ResultsA total of 2,709 participants were recruited with a mean age of 28 years (SD = 5.4) and a median gestational age (GA) of eight weeks (interquartile range [IQR] = 2). The prevalence of GDM in first trimester (T1) was 15.0% (95% confidence interval [CI] = 13.7–16.4). Previously undiagnosed DM was detected among 2.5% of the participants. Out of 2,285 live births with a median delivery GA of 38 weeks (IQR = 3), 7.0% were LGA neonates. The cumulative incidence of LGA neonates in women with GDM and DM was 11.1 and 15.5 per 100 women, respectively. The relative risk of having an LGA neonate among women with DM and GDM was 2.30 (95% CI = 1.23–4.28) and 1.80 (95% CI = 1.27–2.53), respectively. The attributable risk percentage of a LGA neonate for hyperglycaemia was 15.01%. T1 fasting PG was significantly correlated with both neonatal birth weight and birth weight centile.ConclusionsThe proposed WHO criteria for hyperglycaemia in pregnancy are valid, even in T1, for predicting LGA neonates. The use of IADPSG threshold for Fasting PG, for risk assessment in early pregnancy in high-risk populations is recommended.

Highlights

With physiological changes, the maternal plasma glucose (PG) level behaves differently throughout the trimesters of pregnancy [1]
This study provides evidence on the occurrence of hyperglycaemia early in gestation, the adverse effect of hyperglycaemia in early pregnancy on birth weight and the validity of the IADPSG fasting plasma glucose (FPG) threshold for FPG in gestational diabetes mellitus (GDM) detection during trimester 1 (T1)
The published work on T1 PG assessment was often done retrospectively using routinely available data, which can lead to a selection bias

Summary

Introduction

The maternal plasma glucose (PG) level behaves differently throughout the trimesters of pregnancy [1]. Hyperglycaemia that is detected during the late second or early third trimester and resolves following delivery is conventionally defined as gestational diabetes mellitus (GDM) [2, 3]. There are several issues associated with the diagnosis of HIP worldwide [6, 7]. There is a lack of consensus on diagnosis, which leads to delays in detection of and intervention for hyperglycaemia-related pregnancy outcomes [2, 8]. Since O’Sullivan and Mahan’s publication on GDM [9], its definition has changed over time, making it challenging to capture undiagnosed diabetes mellitus (DM) and GDM.

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