Early Screening for Gestational Diabetes Using IADPSG Criteria May Be a Useful Predictor for Congenital Anomalies: Preliminary Data from a High-Risk Population

Abstract

Background: Our aim was to investigate whether the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) glycemic thresholds used for detecting hyperglycemia in pregnancy can be predictive for malformations in women with hyperglycemia detected in early pregnancy. Methods: a single-center, retrospective observational trial of 125 mother-infant pairs from singleton pregnancies with hyperglycemia according to the IADPSG criteria diagnosed at the gestational age below 16 weeks. Glucose values obtained from 75-g OGTT (oral glucose tolerance test) were investigated as predictors for congenital malformations in newborns. Results: Characteristics of the cohort: maternal age: 31.5 ± 5.2, pre-pregnancy body mass index (BMI) ≥ 30 kg/m2: 42.0%, gestational age at diagnosis (weeks): 12.0 ± 4.0, and newborns with congenital malformations: 8.8%. Fasting blood glycemia (FBG) and HbA1c (Haemoglobin A1c) at baseline significantly predicted the outcome (expB: 1.06 (1.02–1.1), p = 0.007 and expB: 2.05 (1.24–3.38), p = 0.005, respectively). Both the fasting blood glucose (FBG) value of 5.1 mmol/dL (diagnostic for gestational diabetes mellitus (GDM)) and 5.5 mmol/dL (upper limit for normoglycemia in the general population) significantly increased the likelihood ratio (LR) for fetal malformations: 1.3 (1.1; 1.4) and 1.5 (1.0; 2.4), respectively. Conclusions: (1) Fasting glycemia diagnostic for GDM measured in early pregnancy is associated with a significantly elevated risk for congenital malformations. (2) Our data suggest that women at elevated risks of GDM/diabetes in pregnancy (DiP) should have their fasting blood glucose assessed before becoming pregnant, and the optimization of glycemic control should be considered if the FBG exceeds 5.1 mmol/dL.

Diabetes during Pregnancy: A Maternal Disease Complicating the Course of Pregnancy with Long-Term Deleterious Effects on the Offspring. A Clinical Review

“…An increased rate of congenital malformations among offspring of GDM mothers was recently also demonstrated in other studies [27,28]. In a retrospective study by Zawiejska et al [27], the authors analyzed obstetric data of 125 women without PGDM but were considered to have an elevated risk for developing GDM according to Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria, or presented a fasting glycemia levels above 5.1 mmol/dL during the first trimester. They found that early fasting glycemia diagnostic for GDM (according to the IADPSG criteria) was associated with a significantly increased risk of congenital anomalies, especially cardiac malformations.…”

“…They found that early fasting glycemia diagnostic for GDM (according to the IADPSG criteria) was associated with a significantly increased risk of congenital anomalies, especially cardiac malformations. These pregnant women did not have a diagnosis of hyperglycemia before pregnancy [ 27 ].…”

“…This implies that the reason for the lack of a significant increase in the rate of congenital anomalies in GDM is the fact that it develops after major organogenesis had occurred. Indeed, early initiation of GDM may also increase the rate of congenital malformations [ 27 , 28 ]. Moreover, since the brain develops actively throughout pregnancy, cerebral hemisphere functions may be affected by the GDM-induced metabolic disturbances even in the second half of pregnancy [ 30 ].…”

Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

“…A study of 125 singleton pregnancies diagnosed as eGDM (IADPSG criteria) before 16 weeks of gestation revealed that fasting hyperglycemia was associated with congenital malformation. The mean pre-pregnancy BMI of the study group was 29.1 ± 6.5 k/m 2 [ 74 ]. An OGTT conducted between 18 and 20 weeks correlated with an OGTT at 24–28 weeks and was linked to the development of LGA and neonatal hyperinsulinemia [ 75 ].…”

Recent Advances in Gestational Diabetes Mellitus

“…This Special Issue includes various important findings. For example, Zawiejska et al show that in high-risk women, early screening for GDM using the IADPSG criteria may be a useful predictor of congenital anomalies [2]. Another study showed that inadequate gestational weight gain was very common in a large cohort of GDM with a lower risk for adverse pregnancy outcomes in women with insufficient gestational weight gain [3].…”