Department of Endocrinology, Indraprastha Apollo Hospitals, New Delhi, India.
Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India.
Diabetes Metab Syndr. 2024 Jun;18(6):103051. doi: 10.1016/j.dsx.2024.103051. Epub 2024 Jun 1.
The implication of intermediately elevated fasting plasma glucose (FPG) in the first trimester of pregnancy is uncertain.
The primary outcome of the meta-analysis was to analyze if intermediately elevated first-trimester FPG could predict development of GDM at 24-28 weeks. The secondary outcomes were to determine if the commonly used FPG cut-offs 5.1 mmol/L (92 mg/dL), 5.6 mmol/L (100 mg/dL), and 6.1 mmol/L (110 mg/dL) correlated with adverse pregnancy events.
Databases were searched for articles published from 2010 onwards for studies examining the relationship between first-trimester FPG and adverse fetomaternal outcomes.
A total of sixteen studies involving 115,899 pregnancies satisfied the inclusion criteria.
Women who developed GDM had a significantly higher first-trimester FPG than those who did not [MD 0.29 mmoL/l (5 mg/dL); 95 % CI: 0.21-0.38; P < 0.00001]. First-trimester FPG ≥5.1 mmol/L (92 mg/dL) predicted the development of GDM at 24-28 weeks [RR 3.93 (95 % CI: 2.67-5.77); P < 0.0000], pre-eclampsia [RR 1.55 (95%CI:1.14-2.12); P = 0.006], gestational hypertension [RR1.47 (95%CI:1.20-1.79); P = 0.0001], large-for-gestational-age (LGA) [RR 1.32 (95%CI:1.13-1.54); P = 0.0004], and macrosomia [RR1.29 (95%CI:1.15-1.44); P < 0.001]. However, at the above threshold, the rates of preterm delivery, lower-segment cesarean section (LSCS), small-for gestational age (SGA), and neonatal hypoglycemia were not significantly higher. First-trimester FPG ≥5.6 mmol/L (100 mg/dL) correlated with occurrence of macrosomia [RR1.47 (95 % CI:1.22-1.79); P < 0.0001], LGA [RR 1.43 (95%CI:1.24-1.65); P < 0.00001], and preterm delivery [RR1.51 (95%CI:1.15-1.98); P = 0.003], but not SGA and LSCS.
Only one study reported outcomes at first-trimester FPG of 6.1 mmol/L (110 mg/dL), and hence was not analyzed.
The risk of development of GDM at 24-28 weeks increased linearly with higher first-trimester FPG. First trimester FPG cut-offs of 5.1 mmol/L (92 mg/dL) and 5.6 mmol/L (100 mg/dL) predicted several adverse pregnancy outcomes.
孕早期空腹血糖（FPG）中度升高的意义尚不确定。
该荟萃分析的主要结局是分析孕早期 FPG 中度升高是否可以预测 24-28 周时发生 GDM。次要结局是确定常用的 FPG 切点 5.1mmol/L（92mg/dL）、5.6mmol/L（100mg/dL）和 6.1mmol/L（110mg/dL）是否与不良妊娠结局相关。
检索了 2010 年以后发表的研究孕早期 FPG 与不良母婴结局关系的文献数据库。
共有 16 项研究纳入了 115899 例符合纳入标准的妊娠。
发生 GDM 的孕妇孕早期 FPG 明显高于未发生 GDM 的孕妇[MD 0.29mmol/L（5mg/dL）；95%CI：0.21-0.38；P<0.00001]。孕早期 FPG≥5.1mmol/L（92mg/dL）预测 24-28 周时发生 GDM[RR 3.93（95%CI：2.67-5.77）；P<0.0000]、子痫前期[RR 1.55（95%CI：1.14-2.12）；P=0.006]、妊娠期高血压[RR 1.47（95%CI：1.20-1.79）；P=0.0001]、巨大儿[RR 1.32（95%CI：1.13-1.54）；P=0.0004]和巨大儿[RR 1.29（95%CI：1.15-1.44）；P<0.001]。然而，在上述阈值时，早产、下段剖宫产（LSCS）、小于胎龄儿（SGA）和新生儿低血糖的发生率并无显著升高。孕早期 FPG≥5.6mmol/L（100mg/dL）与巨大儿[RR 1.47（95%CI：1.22-1.79）；P<0.0001]、巨大儿[RR 1.43（95%CI：1.24-1.65）；P<0.00001]和早产[RR 1.51（95%CI：1.15-1.98）；P=0.003]相关，但与 SGA 和 LSCS 无关。
仅有一项研究报告了孕早期 FPG 为 6.1mmol/L（110mg/dL）的结局，因此未进行分析。
孕 24-28 周时发生 GDM 的风险随孕早期 FPG 升高呈线性增加。孕早期 FPG 切点 5.1mmol/L（92mg/dL）和 5.6mmol/L（100mg/dL）可预测多种不良妊娠结局。
