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. 2022 Apr;59(4):535-543.
doi: 10.1007/s00592-021-01828-1. Epub 2022 Jan 1.

Early pregnancy hyperglycaemia as a significant predictor of large for gestational age neonates

Imasha Upulini Jayasinghe  1 , Iresha Sandamali Koralegedara  2 , Suneth Buddhika Agampodi  2
Affiliations

Early pregnancy hyperglycaemia as a significant predictor of large for gestational age neonates

Imasha Upulini Jayasinghe et al. Acta Diabetol. 2022 Apr.

Abstract

Aims: We aimed to determine the effect of early pregnancy hyperglycaemia on having a large for gestational age (LGA) neonate.

Methods: A prospective cohort study was conducted among pregnant women in their first trimester. One-step plasma glucose (PG) evaluation procedure was performed to assess gestational diabetes mellitus (GDM) and diabetes mellitus (DM) in pregnancy as defined by the World Health Organization (WHO) criteria with International Association of Diabetes in Pregnancy Study Group (IADPSG) thresholds. The main outcome studied was large for gestational age neonates (LGA).

Results: A total of 2,709 participants were recruited with a mean age of 28 years (SD = 5.4) and a median gestational age (GA) of eight weeks (interquartile range [IQR] = 2). The prevalence of GDM in first trimester (T1) was 15.0% (95% confidence interval [CI] = 13.7-16.4). Previously undiagnosed DM was detected among 2.5% of the participants. Out of 2,285 live births with a median delivery GA of 38 weeks (IQR = 3), 7.0% were LGA neonates. The cumulative incidence of LGA neonates in women with GDM and DM was 11.1 and 15.5 per 100 women, respectively. The relative risk of having an LGA neonate among women with DM and GDM was 2.30 (95% CI = 1.23-4.28) and 1.80 (95% CI = 1.27-2.53), respectively. The attributable risk percentage of a LGA neonate for hyperglycaemia was 15.01%. T1 fasting PG was significantly correlated with both neonatal birth weight and birth weight centile.

Conclusions: The proposed WHO criteria for hyperglycaemia in pregnancy are valid, even in T1, for predicting LGA neonates. The use of IADPSG threshold for Fasting PG, for risk assessment in early pregnancy in high-risk populations is recommended.

Keywords: First trimester; Gestational diabetes mellitus; Hyperglycaemia; Large for gestational age; Pregnancy.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Participant flow of the study
Fig. 2
Fig. 2
Distribution of fasting plasma glucose (FPG) and oral glucose tolerance test 2-h plasma glucose (2 h-OGTT) values among first trimester pregnant women
Fig. 3
Fig. 3
ROC curve for FPG as a predictor of large for gestational age
See this image and copyright information in PMC

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