Glycemic status during pregnancy according to fasting and post-load glucose values: the association with adverse pregnancy outcomes. An observational study - 29/08/23

Doi : 10.1016/j.diabet.2023.101469

Emmanuel Cosson ^a,^b,^⁎ , Sopio Tatulashvili ^a, Eric Vicaut ^c, Sara Pinto ^d, Meriem Sal ^a, Charlotte Nachtergaele ^c, Narimane Berkane ^a, Amélie Benbara ^e, Marion Fermaut ^e, Jean-Jacques Portal ^c, Lionel Carbillon ^e, Hélène Bihan ^a
^a AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
^b Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
^c AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, Paris, France
^d AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
^e AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Obstetrics and Gynecology, Bondy, France

^⁎Corresponding author: Professor Emmanuel Cosson, Department of Endocrinology-Diabetology-Nutrition, 125 route de Stalingrad, Hôpital Avicenne, 93009 Bobigny, France.Department of Endocrinology-Diabetology-Nutrition125 route de Stalingrad, Hôpital AvicenneBobigny93009France

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Highlights

•	Hyperglycemia in pregnancy (HIP) is diagnosed through fasting and/or post-load (after an oral glucose tolerance test) glucose values.
•	Prognosis of treated HIP may differ according to whether diagnosis is based on high fasting and/or high post-load glucose values.
•	Compared with no HIP, fasting HIP is independently associated with a higher rate of large-for-gestational-age infant.
•	Compared with no HIP, post-load HIP is independently associated with higher preterm delivery and neonatal intensive care unit admission rates.

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Abstract

Aim

. Prognosis of treated hyperglycemia in pregnancy (HIP) may differ according to whether diagnosis following an oral glucose tolerance test (OGTT) is based on high fasting and/or high post-load glucose values.

Methods

. From a multiethnic prospective study, we included 8,339 women screened for HIP after 22 weeks of gestation. We evaluated the risk of large-for-gestational-age (LGA) infant (primary endpoint) and other adverse pregnancy outcomes according to HIP status in four groups defined as follows: no HIP (n=6,832, reference); isolated fasting HIP (n=465), isolated post-load HIP (n=646), and fasting and post-load HIP (n=396).

Results

. After adjusting for age, body mass index, ethnicity, smoking during pregnancy and parity, compared with no HIP, the adjusted odds ratios [95% confidence interval] for LGA infant were higher in the isolated fasting HIP (1.47 [1.11-1.96]) and fasting and post-load HIP (1.65 [1.23-2.21]) groups, but not in the isolated post-load HIP (1.13 [0.86-1.48]) group. The adjusted odds ratios for preterm delivery and neonatal intensive care unit were higher in the post-load HIP group (1.44 [1.03-2.03] and 1.28 [1.04-1.57], respectively), the fasting and post-load HIP group (1.81 [1.23-2.68] and 1.42 [1.10-1.81], respectively) but not in the isolated fasting HIP group (1.34 [0.90-2.00] and 1.20 [0.94-1.52], respectively).

Conclusion

. Despite glucose-lowering care and adjustment for confounders, compared with no HIP, fasting HIP was associated with a higher rate of LGA infant, whereas post-load HIP was associated with higher preterm delivery and neonatal intensive care unit admission rates.

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Keywords : Diabetes in pregnancy, Gestational diabetes mellitus, Hyperglycemia in pregnancy, Oral glucose tolerance test, Large-for-gestational-age infant, Pregnancy outcomes

Abbreviations : 1h-PG, 2h-PG, BMI, DIP, FPG, GDM, HIP, HOMA-B, HOMA-IR, IADPSG, LGA, NICU, OGTT, SGA, WG, WHO