First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes.

Ping Li,Jianhui Fan,Ling Li,Shuo Lin,Jinhui Cui,Shuisheng Zhou

doi:10.12669/pjms.35.1.216

Abstract

Objective:To evaluate the usefulness of a fasting plasma glucose (FPG) at the first trimester in predicting gestational diabetes mellitus (GDM) and the association between FPG and adverse pregnancy outcomes.Methods:The levels of FPG in women with singleton pregnancies were measured at 9-13+6 weeks. A two hour 75-g oral glucose tolerance test (OGTT) was completed at 24-28 weeks and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria was used. Adverse pregnancy outcomes were assessed and recorded.Results:Among 2112 pregnant women enrolled in the study, 224 (10.6%) subjects were diagnosed with GDM. The AUC for FPG in predicting GDM was 0.63 (95% CI 0.61- 0.65) and the optimal cutoff value was 4.5 mmol/L (sensitivity 64.29% and specificity 56.45%). Higher first-trimester FPG increased the prevalence of GDM, large for gestational age (LGA) and assisted vaginal delivery and/or cesarean section (all P < 0.05).Conclusion:FPG at first trimester could be used to predict GDM and higher first-trimester FPG was associated with adverse pregnancy outcomes.

Highlights

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and the incidence of GDM is increasing globally.[1,2] Women with GDM are associated with many maternal and fetal consequences.[3,4] Commonly, GDM can be diagnosed by using the oral glucose tolerance test (OGTT) during 24-28 weeks of gestation
Higher first-trimester fasting plasma glucose (FPG) was associated with adverse pregnancy outcomes
In the study of Sacks,[18] though they concluded that the specificity of FPG for screening GDM in the first trimester was poor by using a one hour 50-g glucose challenge test (GCT), the AUC was 0.7 which meant FPG still had the diagnostic accuracy for predicting GDM (AUC >0.5)

Summary

Introduction

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and the incidence of GDM is increasing globally.[1,2] Women with GDM are associated with many maternal (preeclampsia, cesarean section, birth injuries) and fetal consequences (macrosomia, hypoglycemia, shoulder dystocia).[3,4] Commonly, GDM can be diagnosed by using the oral glucose tolerance test (OGTT) during 24-28 weeks of gestation. Maternal metabolic status at the early stage of pregnancy may affect maternal and perinatal outcomes.[5] appropriate diet and medication interventions can reduce the incidence of GDM.[6,7] early detection of women at high risk of GDM is clinically important.

Methods

Discussion

Conclusion