Prognosis associated with initial care of increased fasting glucose in early pregnancy: A retrospective study - 22/10/20

Doi : 10.1016/j.diabet.2020.08.007

E. Cosson ^a,^b,^⁎ , E. Vicaut ^c, N. Berkane ^a, T.L. Cianganu ^d, C. Baudry ^a, J.-J. Portal ^c, J. Boujenah ^e, P. Valensi ^d, L. Carbillon ^e
^a AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
^b Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE/CNAM/Université Paris 13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
^c AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, Paris, France
^d AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
^e AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Obstetrics and Gynecology, Bondy, France

^⁎Corresponding author at: Department of Endocrinology-Diabetology-Nutrition, 125 route de Stalingrad, Hôpital Avicenne, 93009 Bobigny, France.Department of Endocrinology-Diabetology-Nutrition125 route de Stalingrad, Hôpital AvicenneBobigny93009France

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Abstract

Aim

To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1–6.9mmol/L before 22 weeks of gestation (WG), termed ‘early fasting hyperglycaemia’, is associated with fewer adverse outcomes than no initial care.

Methods

A total of 523 women with early fasting hyperglycaemia were retrospectively selected in our department (2012–2016) and separated into two groups: (i) those who received immediate care (n=255); and (ii) those who did not (n=268), but had an oral glucose tolerance test (OGTT) at or after 22 WG, with subsequent standard care if hyperglycaemia (by WHO criteria) was present. The number of cases of large-for-gestational age (LGA) infants, shoulder dystocia and preeclampsia with initial care of early fasting hyperglycaemia were compared after propensity score modelling and accounting for covariates.

Results

Of the 268 women with no initial care, 134 had hyperglycaemia after 22 WG and then received care. Women who received initial care vs those who did not were more likely to be insulin-treated during pregnancy (58.0% vs 20.9%, respectively; P<0.00001), gained less gestational weight (8.6±5.4kg vs 10.8±6.1kg, respectively; P<0.00001), had a lower rate of preeclampsia [1.2% vs 2.6%, respectively; adjusted odds ratio (aOR): 0.247 (0.082–0.759), P=0.01], and similar rates of LGA infants (12.2% vs 11.9%, respectively) and shoulder dystocia (1.6% vs 1.5%, respectively). When initial FPG levels were ≥5.5mmol/L (prespecified group, n=137), there was a lower rate of LGA infants [6.7% vs 16.1%, respectively; aOR: 0.332 (0.122–0.898); P=0.03].

Conclusion

Treating women with early fasting hyperglycaemia, especially when FPG is ≥5.5mmol/L, may improve pregnancy outcomes, although this now needs to be confirmed by randomized clinical trials.

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Abbreviations : BMI, GDM, FIGO, FPG, IADPSG, IPTW, LGA, OGTT, RCT, WG, WHO