medwireNews: Women should only be screened for hyperglycemia in early pregnancy if they carry risk factors for gestational diabetes, French researchers propose.
In their case–control study of 268 women who delivered at a suburban Paris hospital between 2012 and 2016, only half of those with untreated early high fasting plasma glucose (FPG) of between 5.1 and 6.9 mmol/L at a mean of 10.2 weeks’ gestation went on to be diagnosed with later gestational diabetes.
“We have confirmed a clear weakness in some recommendations proposing that FPG in the 5.1–6.9 mmol/l range should be considered for diagnosis of hyperglycaemia at any time during pregnancy,” says the team.
While the 134 women who did develop gestational diabetes at 22 weeks were 3.16 times more likely to have an early FPG of at least 5.5 mmol/L compared with the 134 who did not, there were other significant independent risk factors.
These included a 2.78-fold increased likelihood of being aged at least 30 years, a 2.12-fold increased likelihood of being obese before conception, and a 1.87-fold increased likelihood of having a family history of diabetes compared with those who did not develop gestational diabetes.
Women with gestational diabetes were also approximately half as likely as those who did not develop the condition to be employed (odds ratio=0.46).
Gestational diabetes developed in just two of the 15 women with untreated early fasting hyperglycemia who did not have any of the identified risk factors. By contrast, 132 (52%) of the 253 women with early fasting hyperglycemia and at least one of these risk factors developed the condition.
Women with gestational diabetes were 2.16 times more likely to experience adverse birth outcomes even after receiving treatment, with these defined as a composite of pre-eclampsia, an infant that was large for gestational age, shoulder dystocia, or neonatal hypoglycemia.
“The rate of large-for-gestational-age infants was particularly high (16%),” Emmanuel Cosson (Paris 13 University) and co-workers note in Diabetic Medicine. “This worse prognosis was partially driven by confounding factors, especially [gestational diabetes] risk factors such as obesity.”
They conclude: “We show that women with [early fasting hyperglycemia] without risk factors are very unlikely to develop further [gestational diabetes]. According to these results, we suggest that screening for hyperglycaemia in early pregnancy should only be performed in women with risk factors for [gestational diabetes].
“We also suggest that women with FPG level ≥5.5 mmol/L be considered for immediate treatment. As women with untreated [early fasting hyperglycemia] who subsequently develop [gestational diabetes] have a poor prognosis despite treatment after [oral glucose tolerance test], earlier treatment might reduce adverse outcomes.”
By Anita Chakraverty
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Diabet Med 2019; doi:10.1111/dme.14141