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Early Screening for Gestational Diabetes Using IADPSG Criteria May Be a Useful Predictor for Congenital Anomalies:
Agnieszka Zawiejska1, Katarzyna Wróblewska-Seniuk2, Paweł Gutaj1
1Department of Reproduction, Poznan University of Medical Sciences, 60-512 Poznan, Poland.
Insights
Early pregnancy hyperglycemia, even when diagnosed as gestational diabetes mellitus (GDM), significantly increases the risk of congenital malformations. Pre-pregnancy fasting blood glucose assessment is recommended for high-risk women to optimize glycemic control and mitigate risks.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Perinatal Medicine
Background:
- Hyperglycemia in pregnancy poses risks to both mother and fetus.
- The International Association of the Diabetes and Pregnancy Study Groups (IADPSG) established glycemic thresholds for diagnosing hyperglycemia in pregnancy.
- Early detection and management of hyperglycemia are crucial for improving pregnancy outcomes.
Purpose of the Study:
- To evaluate if IADPSG glycemic thresholds for hyperglycemia in early pregnancy predict congenital malformations.
- To assess the association between early pregnancy hyperglycemia and the risk of fetal malformations.
Main Methods:
- A retrospective observational study of 125 mother-infant pairs with hyperglycemia diagnosed before 16 weeks of gestation.
- Analysis of glucose values from a 75-g oral glucose tolerance test (OGTT) as predictors of congenital malformations.
- Inclusion of baseline fasting blood glucose (FBG) and HbA1c levels in the analysis.
Main Results:
- Congenital malformations were observed in 8.8% of newborns.
- Baseline FBG and HbA1c levels significantly predicted adverse outcomes.
- FBG levels of 5.1 mmol/dL (diagnostic for GDM) and 5.5 mmol/dL increased the likelihood of fetal malformations.
Conclusions:
- Fasting glycemia diagnostic for GDM in early pregnancy is linked to an elevated risk of congenital malformations.
- Women at high risk for diabetes in pregnancy (DiP) should undergo pre-pregnancy fasting blood glucose assessment.
- Glycemic control optimization is advised if pre-pregnancy FBG exceeds 5.1 mmol/dL.
Background:
Our aim was to investigate whether the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) glycemic thresholds used for detecting hyperglycemia in pregnancy can be predictive for malformations in women with hyperglycemia detected in early pregnancy.
Methods:
a single-center, retrospective observational trial of 125 mother-infant pairs from singleton pregnancies with hyperglycemia according to the IADPSG criteria diagnosed at the gestational age below 16 weeks. Glucose values obtained from 75-g OGTT (oral glucose tolerance test) were investigated as predictors for congenital malformations in newborns.
Results:
Characteristics of the cohort: maternal age: 31.5 ± 5.2, pre-pregnancy body mass index (BMI) ≥ 30 kg/m2: 42.0%, gestational age at diagnosis (weeks): 12.0 ± 4.0, and newborns with congenital malformations: 8.8%. Fasting blood glycemia (FBG) and HbA1c (Haemoglobin A1c) at baseline significantly predicted the outcome (expB: 1.06 (1.02-1.1), p = 0.007 and expB: 2.05 (1.24-3.38), p = 0.005, respectively). Both the fasting blood glucose (FBG) value of 5.1 mmol/dL (diagnostic for gestational diabetes mellitus (GDM)) and 5.5 mmol/dL (upper limit for normoglycemia in the general population) significantly increased the likelihood ratio (LR) for fetal malformations: 1.3 (1.1; 1.4) and 1.5 (1.0; 2.4), respectively.
Conclusions:
(1) Fasting glycemia diagnostic for GDM measured in early pregnancy is associated with a significantly elevated risk for congenital malformations. (2) Our data suggest that women at elevated risks of GDM/diabetes in pregnancy (DiP) should have their fasting blood glucose assessed before becoming pregnant, and the optimization of glycemic control should be considered if the FBG exceeds 5.1 mmol/dL.
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