Introduction: The association of fasting glucose (FG) in early pregnancy (EP) with adverse outcomes for the mother and her offspring is well known, although the best cut-offs for diagnosis of Gestational Diabetes (GD) are not consensual.
Objetive: Evaluate the impact of FG in EP in the management of pregnant women and obstetric and fetal outcomes.
Methods: Retrospective cohort of pregnant women with GD diagnosed before 24 weeks of gestation using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, attending Baixo Vouga Hospital Center, in Portugal, with follow-up between January 2015 and June 2018. FG was stratified into 3 categories: 1 9294 mg/dl; 2 9599 mg/dl; 3 100125 mg/dl. Maternal and fetal outcomes were evaluated. Statistical analysis was performed using Statistical Package for the Social Sciences® v. 24.
Results: A total of 222 women were included, 15.3% of which had GD in a previous pregnancy. Mean age at diagnosis was 33.0±5.5 years and mean FG was 96.7±5.9 mg/dl (92125). Of these, 47.3% (n=105) were treated with nutritional therapy (NT) only, 18.0% (n=40) with oral antidiabetic drugs, 27.9% (n=62) with insulin and 6.8% (n=15) with both. Preterm labour occurred in 18 women (8.1%) and cesarean delivery was performed in 71 (32.0%). Within the offspring, 11.3% (n=25) were large for gestational age and 16.7% (n=37) had perinatal morbidity. Maternal prepregnancy Body Mass Index (BMI) was positively correlated with FG (r=0.192, P<0.05). FG did not correlate with adverse obstetric, fetal or neonatal outcomes. Mean FG was significantly higher in women with prior GD, as well as in those who required pharmacological therapy (PT) (97.7±6.6 mg/dl vs 95.2±4.4 mg/dl under NT, P<0.05). When divided into categories, FG was still significantly related with PT (required in 44.7% women in category 1, 51.5% in category 2 and 70.0% in category 3 (P<0.05)). Using logistic regression, FG didnt have predictive value for the need of PT [P=0.107; OR 1.107 (0.978 1.253)].
Conclusion: Pregnant women who needed PT had higher levels of FG at diagnosis, but these werent predictive of need for PT or associated with worst obstetric and fetal outcomes. These results were similar when FG was analyzed in categories.
18 - 21 May 2019
European Society of Endocrinology