Endocrine Abstracts

JOINT1814

Introduction: Traditionally GDM has been diagnosed as hyperglycemia in 24-28 weeks of gestation. Glucose abnormalities seen before this period were attributed to pre-existing or undetected diabetes. However, the HAPO study has changed this understanding, recognizing that any degree of hyperglycemia at any gestational age can increase the risk of adverse outcomes for the mother, fetus, and newborn. Early GDM (eGDM) occurring before 20 weeks of gestation, likely represents an intermediate state between normal glucose metabolism and prediabetes/diabetes outside of pregnancy. The clinical impacts of eGDM are still debatable.

Materials & Methods: All eligible patients diagnosed with early GDM according to the World Health Organization (WHO 2013) criteria were prospectively followed after the placement of the Freestyle Libre Pro CGMS on the day of diagnosis between September 2021 and May 2023. The 24-hour glycemic profile of women with eGDM was compared with that of age- and gestational-age-matched normoglycemic pregnant women.

Results: Thirty-nine early GDM patients whose mean age was 29. 4 ± 2. 4 years with a gestational age of 12. 9±4. 2 weeks and 113 pregnant women with normoglycemia whose mean age was 27. 6 ± 3. 8 years and gestational age of 13. 4±4. 5 weeks were enrolled in the study. Glycemic variability indices like standard deviation of blood glucose, J index, and mean amplitude of glycemic excursions were also significantly higher in eGDM patients. Women with eGDM showed a similar "time in range"(93. 4% vs. 89. 1%, p=. 73) and a considerably higher "time above range"(2% vs. vs1. 7%, p=<0. 05) compared to those with normoglycemia. While in most cases glycemic targets could be achieved with lifestyle interventions, 2 out of 39 patients (5%) required insulin therapy. Forty-three percent of women with eGDM had a normal vaginal delivery, 23% experienced neonatal complications, and 10% had macrosomia. Maternal and fetal outcomes differed significantly between the early GDM and normoglycemia groups.

Conclusion: Women with early GDM, despite mild hyperglycemia, exhibit abnormal glycemic patterns on CGMS and higher rates of macrosomia and neonatal complications in a South Asian population, though the small sample size in the eGDM group remains a limitation.