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

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.
 How to cite this:Li P, Lin S, Li L, Cui J, Zhou S, Fan J. First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.216
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Prognostic models versus single risk factor approach in first‐trimester selective screening for gestational diabetes mellitus: a prospective population‐based multicentre cohort study

“…Sweeting et al 36 also found higher first‐trimester glucose levels in women with GDM compared with controls, but did not include glucose in their final model. Reported discrimination for first‐trimester glucose only was similar to our findings, with c ‐statistics ranging from 0.58 to 0.73 in literature compared with 0.68 (95% CI 0.65–0.72) in our study 37–43 …”

“…Reported discrimination for first-trimester glucose only was similar to our findings, with c-statistics ranging from 0.58 to 0.73 in literature compared with 0.68 (95% CI 0.65-0.72) in our study. [37][38][39][40][41][42][43] Risk factors are embedded in most international guidelines for GDM and these could all potentially benefit by replacing their risk-factor-based approach with a more efficient prognostic model. 13 In countries were glucose is not routinely measured in the first trimester of pregnancy, implementation of a prognostic model for GDM can still be considered, as most prognostic models without the addition of glucose seem to outperform the reference method as well.…”

Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes

“…Riskin-Mashiah S et al reported a strong, graded association between FPG levels in the first trimester and the frequency of LGA neonates and macrosomia (2.82 [1.67-4.76]) and the Cs rate (1.94 [1.11-3.41]) [10] . Another retrospective study conducted by Li P et al also found that the prevalence of LGA and assisted vaginal delivery/Cs significantly increased as FPG increased in the first trimester [15] . Certainly, both studies found a strong association between first-trimester maternal FPG and the development of GDM.…”

Early triglyceride and glucose index as a risk marker for gestational diabetes mellitus

“…Individually, FPG and triglycerides have been tested to predict the risk of GDM. FPG was studied in retrospective 16,17 and prospective 18,19 studies using different GDM algorithms. Overall, FPG levels above 81 to 90 mg/dL have been described for pregnancies complicated with GDM.…”