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First-trimester fasting glycemia as a predictor of gestational diabetes (GDM) and adverse pregnancy outcomes

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Abstract

Aims

Studies to prevent gestational diabetes (GDM) have shown the best results when lifestyle measures have been applied early in pregnancy. We aimed to investigate whether first-trimester fasting plasma glucose (FPG) could predict GDM risk and adverse pregnancy outcomes.

Methods

A retrospective analysis of prospectively collected data from singleton pregnancies who were attended at our hospital between 2008 and 2018 (n = 27,198) was performed. We included patients with a recorded first-trimester FPG and complete pregnancy data (n = 6845). Patients under 18, with pregestational diabetes or reproductive techniques, were excluded. First-trimester FPG was evaluated as a continuous variable and divided into quartiles. GDM was diagnosed by NDDG criteria. The relationship between first- and second-trimester glucose > 92 mg/dL was also investigated. The relationship between FPG and pregnancy outcomes was assessed in 6150 patients who did not have GDM.

Results

Maternal age was 34.2 ± 3.9 years, BMI 23.1 ± 3.7 kg/m2 and mean FPG 83.0 ± 7.3 mg/dL. Glucose quartiles were: ≤ 78, 79–83, 84–87 and ≥ 88 mg/dL. First-trimester FPG predicted the risk of GDM (7%, 8%, 10.2% and 16% in each quartile, p < 0.001) and the risk of second-trimester glucose > 92 mg/dL (2.6%, 3.8%, 6.3% and 11.4% in each quartile, p < 0.001). FPG was significantly associated with LGA (8.2%, 9.3%, 10% and 11.7% in each quartile, p = 0.011) but not with other obstetrical outcomes. In a multivariate analysis including age, BMI, tobacco use, number of pregnancies and weight gained during pregnancy, first-trimester FPG was an independent predictor of LGA.

Conclusions

First-trimester FPG is an early marker of GDM and LGA.

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Acknowledgements

This study was conducetd under the auspices of the Cátedra d'Investigació en Obstetrícia i Ginecologia de la Universitat Autònoma de Barcelona.

Funding

None.

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Authors and Affiliations

  1. Endocrine Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain

    G. Sesmilo & I. Berges

  2. Obstetrical, Gynecologic and Reproductive Unit, Hospital Universitari Quirón-Dexeus, C/Sabino de Arana 5-19, 08028, Barcelona, Spain

    P. Prats, S. Garcia, I. Rodríguez, A. Rodríguez-Melcón & B. Serra

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  1. G. Sesmilo
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Contributions

GS and PP conceived the project. SG and NR did the statistical analysis. GS did the literature review. GS wrote the first draft of the manuscript. All authors contributed to the study design, including data collection, data interpretation and manuscript revision.

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Correspondence to G. Sesmilo.

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The authors declare that they have no conflict of interest.

Ethical standards

The protocol was approved by the Dexeus Institutional Review Board for Human Investigation and the Ethics Committee.

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Informed consent was obtained from all patients, and the reported investigations were carried out in accordance with the principles of the Declaration of Helsinki as revised in 2008.

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This article belongs to the topical collection Pregnancy and diabetes, managed by Antonio Secchi and Marina Scavini.

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Sesmilo, G., Prats, P., Garcia, S. et al. First-trimester fasting glycemia as a predictor of gestational diabetes (GDM) and adverse pregnancy outcomes. Acta Diabetol 57, 697–703 (2020). https://doi.org/10.1007/s00592-019-01474-8

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