The diagnosis of "pathological hyperglycaemia' in gestational diabetes in a high risk obstetric population

Area of Science:

• Obstetrics and Gynecology
• Endocrinology
• Perinatal Medicine

Background:

• Defining pathological hyperglycemia in pregnancy is crucial for predicting perinatal outcomes.
• Glucose intolerance during pregnancy can lead to adverse maternal and fetal complications.
• Existing diagnostic criteria for gestational diabetes require refinement for accurate risk stratification.

Purpose of the Study:

• To define a threshold for pathological hyperglycemia in pregnant women using glucose tolerance tests (GTTs).
• To assess the predictive value of GTT results for perinatal morbidity.
• To differentiate between gestational diabetes mellitus (GDM) and gestational induced hyperglycemia (GIH).

Main Methods:

• 100g GTTs were performed on 660 pregnant women attending antenatal care.
• Patients were stratified by the number of abnormal glucose values and by diagnostic criteria (normal, GDM, GIH).
• Fasting blood glucose (FBG) levels were analyzed in relation to maternal and fetal morbidity.

Main Results:

• A stepwise association was observed between increasing abnormal GTT values and fetal/maternal morbidity.
• Patients with GDM (FBG ≥5.8 mmol/L) were significantly heavier and had higher rates of macrosomia and operative delivery.
• No specific GTT abnormality level predicted normal response, but FBG ≥5.8 mmol/L emerged as a significant threshold.

Conclusions:

• A fasting blood glucose level of ≥5.8 mmol/L in women with abnormal GTT results identifies a threshold for pathological hyperglycemia.
• This threshold is associated with increased perinatal morbidity, including macrosomia and operative delivery.
• FBG ≥5.8 mmol/L can serve as a clinically relevant indicator for identifying high-risk pregnancies requiring closer monitoring.