FPG predicts pregnancy complications in gestational diabetes
Click Here to Manage Email Alerts
Fasting plasma glucose level, rather than 1-hour or 2-hour glucose, may be a better indicator of risk for pregnancy complications such as large for gestational age and hypertensive disorders, according to findings published in Diabetic Medicine.
“Our study, which uses data from a large population-based cohort of pregnant women who had equal access to health care, suggests that elevated fasting glucose values may be more important than post-load values in identifying women at higher risk of having large babies or hypertension during pregnancy,” Padma Kaul, PhD, professor of medicine and co-director of the Canadian VIGOUR Centre at the University of Alberta in Edmonton, Alberta, Canada, told Healio. “This information can be used to improve treatment strategies and reduce adverse outcomes of pregnancy in women with gestational diabetes.”
Kaul and colleagues assessed birth results from Alberta residents who were pregnant and gave birth between October 2008 and December 2014. The researchers also assessed the number of diagnoses of gestational diabetes based on an FPG level of 5.3 mmol/L or more, a 1-hour glucose level of 10.6 mmol/L or more or a 2-hour glucose level of 8.9 mmol/L or more.
Gestational diabetes was diagnosed using FPG in 4,130 pregnancies and by either 1-hour or 2-hour oral glucose tolerance tests in 8,812 pregnancies.
A larger proportion of pregnancies with gestational diabetes based on FPG resulted in large for gestational age births (22.4%) compared with those based on 1-hour glucose or 2-hour glucose (9.1%), those with a negative OGTT (11%) and those that did not include an OGTT (8.1%; P < .001 for all).
The risk for large for gestational age was greater for pregnancies with gestational diabetes based on FPG vs. those based on 1-hour glucose or 2-hour glucose (adjusted OR = 2.66; 95% CI, 2.39-2.96).
As for hypertensive disorders of pregnancy, a larger proportion of pregnancies with gestational diabetes based on FPG resulted in these conditions (11.9%) compared with those based on 1-hour glucose or 2-hour glucose (8%), those with a negative OGTT (7%) and those that did not include an OGTT (5.1%; P < .001 for all).
The risk for hypertensive disorders of pregnancy was greater for pregnancies with gestational diabetes based on FPG vs. those based on 1-hour glucose or 2-hour glucose (aOR = 1.51; 95% CI, 1.33-1.72).
The researchers noted that pregnancies with gestational diabetes based on FPG had a larger proportion of cesarean sections, preterm deliveries and inductions (P < .001 for all). In addition, among those pregnancies that exceeded multiple thresholds for gestational diabetes, pregnancies that included the diagnosis based on FPG had “the highest rates of adverse events,” the researchers wrote, adding that medical therapy did not make a difference in the overall results seen for FPG-based gestational diabetes.
“Our study informs clinicians that women with elevated fasting glucose levels may be at higher risk of adverse pregnancy outcomes,” Kaul said. “This information is likely to impact the way they treat and manage these patients.” – by Phil Neuffer
For more information:
Padma Kaul, PhD, can be reached at pkaul@ualberta.ca.
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Margo B. Minissian, PhD, ACNP, FAHA, FNLA
Adverse pregnancy outcomes, such as gestational diabetes, hypertensive disorders of pregnancy — including preeclampsia — and preterm delivery, have been associated with increased maternal risk for developing future cardiometabolic risk factors, such as diabetes, dyslipidemia and hypertension. Moreover, women who experience an adverse pregnancy outcome are at a twofold to fourfold increased risk for future atherosclerotic cardiovascular disease. Ryan and colleagues examined the relative association between fasting plasma glucose vs. 1-hour and 2-hour post-load glucose levels based on the oral glucose tolerance test in pregnancy and large for gestational age and hypertensive disorders of pregnancy outcomes. This is important because if associated, clinicians may be able to assess these early pregnancy blood markers to anticipate which women are at increased risk for developing an adverse pregnancy outcome.
Women with gestational diabetes had large-for-gestational-age infants and more adverse pregnancy outcomes specifically associated with hypertension, preterm delivery and composite adverse outcomes. Women with gestational diabetes had increased cesarean section and induction rates compared with the other negative glucose challenge test and OGTT groups. The investigators further demonstrated that elevated FPG in women with gestational diabetes is a stronger predictor of large for gestational age and hypertensive disorders of pregnancy outcomes than elevated post-load glucose despite pharmacologic treatment.
This is an important finding for clinicians, to closely monitor women with gestational diabetes with elevated FPG and potentially consider preventive therapies for preeclampsia and closer blood pressure monitoring. These data correlate with other findings in relation to gestational diabetes, metabolic syndrome and their correlation with adverse pregnancy outcomes and subsequent future atherosclerotic CVD risk.
Click Here to Manage Email Alerts