First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes

Objective: To evaluate the usefulness of a fasting plasma glucose (FPG) at the first trimester in predicting gestational diabetes mellitus (GDM) and the association between FPG and adverse pregnancy outcomes. Methods: The levels of FPG in women with singleton pregnancies were measured at 9-13+6 weeks. A two hour 75-g oral glucose tolerance test (OGTT) was completed at 24-28 weeks and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria was used. Adverse pregnancy outcomes were assessed and recorded. Results: Among 2112 pregnant women enrolled in the study, 224 (10.6%) subjects were diagnosed with GDM. The AUC for FPG in predicting GDM was 0.63 (95% CI 0.61- 0.65) and the optimal cutoff value was 4.5 mmol/L (sensitivity 64.29% and specificity 56.45%). Higher first-trimester FPG increased the prevalence of GDM, large for gestational age (LGA) and assisted vaginal delivery and/or cesarean section (all P < 0.05). Conclusion: FPG at first trimester could be used to predict GDM and higher first-trimester FPG was associated with adverse pregnancy outcomes. How to cite this:Li P, Lin S, Li L, Cui J, Zhou S, Fan J. First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.216 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Association of First-Trimester Fasting Plasma Glucose with Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes

Diabetes ◽

10.2337/db18-1448-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1448-P

Author(s):

PING LI ◽

SHUO LIN ◽

LING LI ◽

JINHUI CUI ◽

JIANHUI FAN

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Fasting Plasma ◽

Adverse Pregnancy

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Fasting plasma glucose in the first trimester is related to Gestational Diabetes Mellitus and adverse pregnancy outcomes

10.21203/rs.3.rs-459897/v1 ◽

2021 ◽

Author(s):

Jia-Ning Tong ◽

Lin-Lin Wu ◽

Yi-Xuan Chen ◽

Xiao-Nian Guan ◽

Fu-Ying Tian ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Cesarean Section ◽

Gestational Diabetes Mellitus ◽

Plasma Glucose ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Curve Analysis ◽

Adverse Pregnancy

Abstract PurposeTo investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population.MethodsWe used data of 48,444 pregnant women that had been retrospectively collected between 2017 and 2019. Logistic regression analysis was used to evaluated the associations between first-trimester FPG and GDM and adverse pregnancy outcomes, and used to construct a nomogram model for predicting the risk of GDM. The performance of the nomogram was evaluated by using ROC and calibration curves. Decision curve analysis (DCA) was used to determine the clinical usefulness of the first-trimester FPG by quantifying the net benefits at different threshold probabilities.ResultsThe mean first-trimester FPG was 4.62±0.42 mmol/L. A total of 6998(14.4%) pregnancies developed GDM.489(1.01%) pregnancies developed polyhydramnios, the prevalence rates of gestational hypertensive disorder (GHD), cesarean section, primary cesarean section, preterm delivery before 37 weeks (PD) and dystocia was 1130(2.33%), 20426(42.16%), 7237(14.94%), 2386(4.93%) and 1865(3.85%), respectively. 4233(8.74%) of the newborns were LGA, and the number of macrosomia was 2272(4.69%), LBW was 1701(3.51%) and 5084(10.49%) newborns had admission to the ICU, which all showed significances between GDM and non-GDM groups (all P<0.05). The univariate analysis showed that first-trimester FPG was strongly associated with risks of outcomes including GDM, cesarean section, macrosomia, GHD, primary cesarean section and LGA (all OR>1, all P<0.05), furthermore, the risks of GDM, primary cesarean section and LGA was increasing with first-trimester FPG as early as it was at 4.19-4.63 mmol/L. The multivariable analysis showed that the risks of GDM (ORs for FPG 4.19-4.63, 4.63-5.11 and 5.11-7.0 mmol/L were 1.137, 1.592 and 4.031, respectively, all P <0.05) increased as early as first-trimester FPG was at 4.19-4.63 mmol/L,and first-trimester FPG which was also associated with the risks of cesarean section, macrosomia and LGA (OR for FPG 5.11-7.0 mmol/L of cesarean section: 1.128; OR for FPG 5.11-7.0 mmol/L of macrosomia: 1.561; OR for FPG 4.63-5.11 and 5.11-7.0 mmol/L of LGA: 1.149 and 1.426, respectively, all P <0.05) and with its increasing, the risks of LGA increased. Furthermore, the nomogram had a C-indices 0.771(95%CI: 0.763~0.779) and 0.770(95%CI:0.758~0.781) in training and testing validation respectively, which showed an acceptable consistency between the observed, validation and nomogram-predicted probabilities, the DAC curve analysis indicated that the nomogram had important clinical application value for GDM risk prediction.ConclusionsFPG in the first trimester was an independent risk factor for GDM which can be used as a screening test for identifying pregnancies at risk of GDM and adverse pregnancy outcomes.

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Fasting plasma glucose in the first trimester is related to gestational diabetes mellitus and adverse pregnancy outcomes

Endocrine ◽

10.1007/s12020-021-02831-w ◽

2021 ◽

Author(s):

Jia-Ning Tong ◽

Lin-Lin Wu ◽

Yi-Xuan Chen ◽

Xiao-Nian Guan ◽

Fu-Ying Tian ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Cesarean Section ◽

Gestational Diabetes Mellitus ◽

Plasma Glucose ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Curve Analysis ◽

Adverse Pregnancy

Abstract Purpose To investigate and identify first-trimester fasting plasma glucose (FPG) is related to gestational diabetes mellitus (GDM) and other adverse pregnancy outcomes in Shenzhen population. Methods We used data of 48,444 pregnant women that had been retrospectively collected between 2017 and 2019. Logistic regression analysis was used to evaluated the associations between first-trimester FPG and GDM and adverse pregnancy outcomes, and used to construct a nomogram model for predicting the risk of GDM. The performance of the nomogram was evaluated by using ROC and calibration curves. Decision curve analysis (DCA) was used to determine the clinical usefulness of the first-trimester FPG by quantifying the net benefits at different threshold probabilities. Results The mean first-trimester FPG was 4.62 ± 0.42 mmol/L. A total of 6998 (14.4%) pregnancies developed GDM.489(1.01%) pregnancies developed polyhydramnios, the prevalence rates of gestational hypertensive disorder (GHD), cesarean section, primary cesarean section, preterm delivery before 37 weeks (PD) and dystocia was 1130 (2.33%), 20,426 (42.16%), 7237 (14.94%), 2386 (4.93%), and 1865 (3.85%), respectively. 4233 (8.74%) of the newborns were LGA, and the number of macrosomia was 2272 (4.69%), LBW was 1701 (3.51%) and 5084 (10.49%) newborns had admission to the ICU, which all showed significances between GDM and non-GDM groups (all P < 0.05). The univariate analysis showed that first-trimester FPG was strongly associated with risks of outcomes including GDM, cesarean section, macrosomia, GHD, primary cesarean section, and LGA (all OR > 1, all P < 0.05), furthermore, the risks of GDM, primary cesarean section, and LGA was increasing with first-trimester FPG as early as it was at 4.19–4.63 mmol/L. The multivariable analysis showed that the risks of GDM (ORs for FPG 4.19–4.63, 4.63–5.11 and 5.11–7.0 mmol/L were 1.137, 1.592, and 4.031, respectively, all P < 0.05) increased as early as first-trimester FPG was at 4.19–4.63 mmol/L, and first-trimester FPG which was also associated with the risks of cesarean section, macrosomia and LGA (OR for FPG 5.11–7.0 mmol/L of cesarean section: 1.128; OR for FPG 5.11–7.0 mmol/L of macrosomia: 1.561; OR for FPG 4.63–5.11 and 5.11–7.0 mmol/L of LGA: 1.149 and 1.426, respectively, all P < 0.05) and with its increasing, the risks of LGA increased. Furthermore, the nomogram had a C-indices 0.771(95% CI: 0.763~0.779) and 0.770(95% CI:0.758~0.781) in training and testing validation respectively, which showed an acceptable consistency between the observed, validation and nomogram-predicted probabilities, the DAC curve analysis indicated that the nomogram had important clinical application value for GDM risk prediction. Conclusions FPG in the first trimester was an independent risk factor for GDM which can be used as a screening test for identifying pregnancies at risk of GDM and adverse pregnancy outcomes.

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Elevated First-Trimester Neutrophil Count Is Closely Associated with the Development of Maternal Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes

10.2337/db20-4567/suppl.12145296 ◽

2020 ◽

Author(s):

Ada Admin ◽

Tiange Sun ◽

Fanhua Meng ◽

Hongmei Zhao ◽

Min Yang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Blood Cell ◽

Gestational Diabetes Mellitus ◽

Neutrophil Count ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Newborn Weight ◽

Adverse Pregnancy

Chronic low-grade inflammation plays a central role in the pathophysiology of gestational diabetes mellitus (GDM). In order to investigate the ability of different <a></a><a>inflammatory blood cell parameters</a> in predicting the development of GDM and pregnancy outcomes, 258 women with GDM and 1154 women without were included in this retrospective study. First-trimester neutrophil count outperformed white blood cell (WBC) count, and neutrophil-to-lymphocyte ratio (NLR) in the predictability for GDM. Subjects were grouped based on tertiles of neutrophil count during their first-trimester pregnancy. The results showed that as the neutrophil count increased, there was a step-wise increase in GDM incidence, as well as glucose and glycosylated hemoglobin (HbA1c) level, Homeostasis Model Assessment for Insulin Resistance (HOMA-IR), macrosomia incidence and newborn weight. Neutrophil count was positively associated with pre-pregnancy Body Mass Index (BMI), HOMA-IR and newborn weight. Additionally, neutrophil count was an independent risk factor for the development of GDM, regardless of the history of GDM. Spline regression showed that there was a significant linear association between GDM incidence and continuous neutrophil count when it exceeded 5.0 × 10<sup>9</sup>/L. This work suggested that first-trimester neutrophil count is closely associated with the development of GDM and adverse pregnancy outcomes.

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The Association of Gene Variants in the Vitamin D Metabolic Pathway and Its Interaction with Vitamin D on Gestational Diabetes Mellitus: A Prospective Cohort Study

Nutrients ◽

10.3390/nu13124220 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4220

Author(s):

Minjia Mo ◽

Bule Shao ◽

Xing Xin ◽

Wenliang Luo ◽

Shuting Si ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

First Trimester ◽

Postprandial Glucose ◽

Gene Variants ◽

Fasting Plasma

The present prospective study included 2156 women and investigated the effect of gene variants in the vitamin D (VitD) metabolic and glucose pathways and their interaction with VitD levels during pregnancy on gestational diabetes mellitus (GDM). Plasma 25(OH)D concentrations were measured at the first and second trimesters. GDM subtype 1 was defined as those with isolated elevated fasting plasma glucose; GDM subtype 2 were those with isolated elevated postprandial glucose at 1 h and/or 2 h; and GDM subtype 3 were those with both elevated fasting plasma glucose and postprandial glucose. Six Gc isoforms were categorized based on two GC gene variants rs4588 and rs7041, including 1s/1s, 1s/2, 1s/1f, 2/2, 1f/2 and 1f/1f. VDR-rs10783219 and MTNR1B-rs10830962 were associated with increased risks of GDM and GDM subtype 2; interactions between each other as well as with CDKAL1-rs7754840 were observed (Pinteraction < 0.05). Compared with the 1f/1f isoform, the risk of GDM subtype 2 among women with 1f/2, 2/2, 1s/1f, 1s/2 and 1s/1s isoforms and with prepregnancy body mass index ≥24 kg/m2 increased by 5.11, 10.01, 10, 14.23, 19.45 times, respectively. Gene variants in VitD pathway interacts with VitD deficiency at the first trimester on the risk of GDM and GDM subtype 2.

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239: Prediction of gestational diabetes mellitus in the first trimester; comparion of fasting plasma glucose, two-step and one-step methods

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2012.10.404 ◽

2013 ◽

Vol 208 (1) ◽

pp. S110-S111 ◽

Cited By ~ 1

Author(s):

M. Ilkin Yeral ◽

A. Seval Ozgu Erdinc ◽

Dilek Uygur ◽

K. Doga Seckin ◽

M. Fatih Karsli ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

First Trimester ◽

Fasting Plasma ◽

One Step

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Prediction of gestational diabetes mellitus in the first trimester by fasting plasma glucose which cutoff is better?

Archives of Physiology and Biochemistry ◽

10.1080/13813455.2019.1671457 ◽

2019 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

A. Seval Ozgu-Erdinc ◽

Umit Yasemin Sert ◽

Hatice Kansu-Celik ◽

Ozlem Moraloglu Tekin ◽

Yaprak Engin-Ustun

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

First Trimester ◽

Fasting Plasma

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Performance and the Optimal Cut-Off Value of First-Trimester Fasting Plasma Glucose To Identify Gestational Diabetes Mellitus: A Retrospective Study From Southern China

10.21203/rs.3.rs-1067857/v1 ◽

2021 ◽

Author(s):

Jia-Ning Tong ◽

Lin-Lin Wu ◽

Yi-Xuan Chen ◽

Xiao-Nian Guan ◽

Kan Liu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Retrospective Study ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnant Women ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Maternal Age ◽

First Trimester ◽

Fasting Plasma

Abstract Purpose Previous studies have suggested that first-trimester fasting plasma glucose (FPG) is associated with gestational diabetes mellitus (GDM) and is a predictor of GDM. The aim of the present study was to explore whether first-trimester FPG levels can be used as a screening and diagnostic test for GDM in pregnant women. Methods This retrospective study included pregnant women who had their first-trimester FPG recorded at 9-13+6 weeks and underwent screening for GDM using the 2-hour 75 g oral glucose tolerance test (OGTT) between 24th and 28th gestational weeks. The cut-off values were calculated using a receiver operating characteristic (ROC) curve. Results The medical records of 28,030 pregnant women were analysed, and 4,669 (16.66%) of them were diagnosed with GDM. The mean first-trimester FPG was 4.62 ± 0.37 mmol/L. The total trend in the optimal cut-off value of first-trimester FPG in pregnant women was 4.735 mmol/L, with a sensitivity of 49%, a specificity of 67.6% and AUC of 0.608 (95% CI: 0.598-0.617, p༜0.001). Moreover, as the maternal age increased, the optimal cut-off values increased, respectively. The results suggest that first-trimester FPG can be considered a marker for identifying pregnant women with GDM. Conclusion The level of first-trimester FPG increased slightly with maternal age and, as maternal age increased, the optimal cut-off values increased, especially after age 30. The first-trimester FPG should be considered a screening marker when diagnosing GDM in pregnant women.

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