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Prediabetes before pregnancy: implications for risk stratification and research

Saptarshi Bhattacharya1, Viswanathan Mohan2, Lakshmi Nagendra3

  • 1Indraprastha Apollo Hospitals, New Delhi.

Current Opinion in Endocrinology, Diabetes, and Obesity
|May 20, 2026
PubMed

Insights

Pregestational prediabetes, common in women of reproductive age, identifies those at higher risk for gestational diabetes mellitus (GDM). This condition signals underlying metabolic issues with implications beyond pregnancy.

Area of Science:

  • Reproductive Endocrinology
  • Metabolic Health
  • Pregnancy Complications

Background:

  • Prediabetes is prevalent in women of reproductive age and often precedes gestational diabetes mellitus (GDM).
  • Risk factors for prediabetes and GDM overlap, including higher BMI, PCOS, advanced maternal age, and genetic predisposition.
  • Both conditions reflect underlying insulin resistance and compromised beta-cell function.

Purpose of the Study:

  • To assess if pregestational prediabetes identifies women at risk for subsequent GDM.
  • To examine the association of pregestational prediabetes with maternal and offspring outcomes during pregnancy.

Main Methods:

  • This is a review evaluating existing literature.
  • Analysis of studies linking pregestational glycemic status to pregnancy outcomes.

Main Results:

  • Women with pregestational prediabetes show a higher likelihood of developing GDM, with risk increasing with glycemia.
  • Prediabetes is associated with modestly increased risks of hypertensive disorders and preterm birth.
  • Early pregnancy glycated hemoglobin in the prediabetes range predicts higher progression to type 2 diabetes compared to GDM diagnosed later.

Conclusions:

  • Prediabetes signifies heightened metabolic risk in women planning pregnancy, bridging preconception glycemic status to GDM and future diabetes.
  • Glycemic assessment in preconception care could improve GDM risk stratification.
  • Further prospective studies are required to fully define the predictive role of pregestational prediabetes for maternal, fetal, and long-term outcomes.
Abstract

Keywords:
gestational diabetes mellitusglycemic continuuminsulin resistancematernal and fetal outcomespreconceptional careprediabetesrisk stratification

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