First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy

Chaves, Catarina; Cunha, Filipe; Martinho, Mariana; Garrido, Susana; Silva-Vieira, Margarida; Estevinho, Catarina; Melo, Armindo; Figueiredo, Odete; Morgado, Ana; Nogueira, C. E. W.; Almeida, M. C.; Almeida, Margarida

doi:10.1007/s00404-021-06107-6

Cited by 8 publications

(1 citation statement)

References 36 publications

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“…Women with HbA1c above 5.4% were found to have a very high probability of ulterior T2DM or abnormal glucose hemostasis. Therefore, the author suggests that women with HbA1c >5.4% in the first trimester should be recalled if they miss their postpartum OGTT [ 20 ]. In our study, the cutoff value, also defined by a ROC curve, was 5.25%.…”

Section: Discussionmentioning

confidence: 99%

Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes

Taieb,

Majdoub,

Souissi

et al. 2024

Cureus

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The prevalence of gestational diabetes mellitus (GDM) has been steadily increasing over the past years. It is a major risk factor for glucose intolerance and type 2 DM (T2DM). The American Diabetes Association recommends that women whose pregnancy was complicated by GDM be screened for persistent glucose abnormalities at six to 12 weeks postpartum with either a fasting plasma glucose test alone or with a fasting 75-g, two-hour oral glucose tolerance test. This study aimed to identify the main predictive factors of glucose tolerance disorders in early postpartum women with a recent history of GDM. In this retrospective descriptive study, we identified 400 women who met the eligibility criteria for the study. The mean age was 34.54 ± 5.51 years. A total of 70% had a family history of DM, 16% had a personal history of GDM, and 23% had fetal macrosomia in previous pregnancies. The overall incidence of postpartum carbohydrate tolerance disorders was 36.4%, including 12% prediabetes and 24.4% DM. The prevalence of prediabetes and T2DM after delivery was higher with older maternal age, multigravidity, a higher BMI, a history of GDM, and fetal macrosomia in previous pregnancies. Furthermore, the persistence of this impaired glucose tolerance in postpartum was associated with a higher term of diagnosis, a higher glycated hemoglobin (HbA1c) percentage (the discriminant cutoff value with the best sensitivity/specificity ratio was 5.25%), the use of insulin therapy, cesarean section delivery, and fetal macrosomia. After adjusting for confounders, only prior GDM, a higher HbA1c level, macrosomia, and gestational term were found to significantly affect postpartum glucose tolerance. Although postpartum screening for T2DM is recommended for all women with GDM, a significant number of patients fail it. A better knowledge of predictive factors for this outcome is therefore needed for a more effective and targeted medical intervention.

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Section: Discussionmentioning

confidence: 99%

Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes

Taieb,

Majdoub,

Souissi

et al. 2024

Cureus

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First‐trimester fasting plasma glucose levels and progression to type 2 diabetes: A 5‐year cohort study

Maor‐Sagie,

Hallak,

Twig

et al. 2024

Intl J Gynecology & Obste

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ObjectiveImpaired fasting glucose is a prediabetic condition defined as glucose levels of 100–125 mg/dL and is considered a risk factor for type 2 diabetes. However, this definition does not confer to pregnancy. The significance of first‐trimester fasting glucose and future progression to diabetes is not well defined. Therefore, we aimed to evaluate the progression to type 2 diabetes according to first‐ trimester fasting plasma glucose levels, as compared with gestational diabetes, a well‐established risk factor for diabetes, in up to 5‐year follow‐up postpartum.MethodsA retrospective analysis of 69 001 parturients, evaluating fasting plasma glucose levels measured during the first trimester. The primary outcome was the incidence of type 2 diabetes within 5 years post‐delivery. Fasting plasma glucose levels were categorized in 10 mg/dL increments. Receiver operating characteristic‐area under the curve (ROC‐AUC) statistics and the Youden index were employed to identify the optimal fasting plasma glucose cutoff for progression to type 2 diabetes. Survival analysis was applied to calculate the adjusted hazard ratios (aHRs) for type 2 diabetes progression with further stratification to maternal obesity status.ResultsThe identified fasting plasma glucose cutoff for progression to type 2 diabetes was 86.5 mg/dL. This cut‐off demonstrated superior performance compared with gestational diabetes diagnosis. Stratification by maternal obesity revealed enhanced predictive capabilities for type 2 diabetes, particularly among patients without obesity.ConclusionsIncreased first‐trimester fasting plasma glucose levels are associated with progression to type 2 diabetes, at least as gestational diabetes. For patients without obesity, first‐trimester fasting plasma glucose has a more pronounced impact on progression to diabetes.

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Use of oral glucose tolerance testing and HbA1c at 6–14 gestational weeks to predict gestational diabetes mellitus in high-risk women

Peng

Liu

Gang

et al. 2022

Arch Gynecol Obstet

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First trimester fasting glucose and glycated haemoglobin cut-offs associated with abnormal glucose homeostasis in the post-partum reclassification in women with hyperglycaemia in pregnancy

Cited by 8 publications

References 36 publications

Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes

Determination of the Contributing Factors and HbA1c Cutoff Leading to Glucose Tolerance Abnormalities Following Gestational Diabetes

First‐trimester fasting plasma glucose levels and progression to type 2 diabetes: A 5‐year cohort study

Use of oral glucose tolerance testing and HbA1c at 6–14 gestational weeks to predict gestational diabetes mellitus in high-risk women

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