Early-pregnancy intermediate hyperglycaemia and adverse pregnancy outcomes among women without gestational diabetes.

AIMS Universal early-pregnancy screening for overt diabetes reveals intermediate hyperglycaemia [fasting plasma glucose (FPG) (5.1-6.9 mM)]. We evaluated the association between early-pregnancy intermediate hyperglycaemia and adverse pregnancy outcomes among women without gestational diabetes. METHODS This retrospective cohort study, conducted at the Obstetrics and Gynaecology Hospital, Shanghai, China, from 2013-2017. All singleton pregnancies with FPG≤6.9mM in early pregnancy and receiving 75-g oral glucose tolerance test (OGTT) were included. Women with pre-pregnancy diabetes were excluded. Subjects with normal OGTT were analysed. Pregnancy outcomes for FPG<5.1 mM and intermediate hyperglycaemia were evaluated. The primary outcomes were large for gestational age (LGA) and primary caesarean section. Multivariate logistic regressions were conducted. Significance was defined as P<0.05. RESULTS Totally, 24479 deliveries were included, of which 23450 (95.8%) had normal OGTTs later in pregnancy (NGT). There were 807 (3.4%) women had FPG=5.1-6.9 mM in early pregnancy. Compared to the NGT group with FPG<5.1 mM in early pregnancy (N=20692), the intermediate hyperglycaemia NGT group (N=693) had a higher age and BMI, and significantly higher rates of LGA, primary caesarean section, preterm birth, preeclampsia and neonatal distress. The rates of primary caesarean section (AOR 1.24, 95% CI 1.05-1.45), preterm birth (AOR 1.75, 95% CI 1.29-2.36) and neonatal distress (adjusted OR 3.29, 95% CI 1.57-6.89) remained significantly higher after adjustments for maternal age, BMI and other potential confounding factors. CONCLUSIONS Women with intermediate hyperglycaemia in early pregnancy are at an increased risk for adverse maternal-foetal outcomes, even with normal future OGTTs.