ADA 2023: Early Pregnancy Hyperglycemia and Glycemic Status at 24–28 Weeks in Indian Women

The early pregnancy hyperglycemia threshold (FPG ≥92mg/dl or ≥5.1mmol/l) suggested by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) is a topic of debate.  There is a lack of evidence regarding the glycemic status of Indians at 24-28 weeks of pregnancy. Therefore, the study is conducted to understand glycemic status at 24-28 weeks in Indian women with early pregnancy hyperglycemia. The STratification of Risk of Diabetes in Early Pregnancy (STRiDE) study was performed to investigate the impact of HbA1c levels during early pregnancy on the development of gestational diabetes mellitus (GDM). 2,703 pregnant women were recruited from 7 centres in South India, of which 566 (20.9%) had early pregnancy hyperglycemia. Among these women, 477 underwent screening at 24-28 weeks, with 150 undergoing oral glucose tolerance test (OGTT) and 327 undergoing fasting plasma glucose (FPG) testing.

The study revealed approximately 32.7% of women exhibited abnormal glucose values at 24-28 weeks, indicated by high fasting plasma glucose (FPG) levels or gestational diabetes mellitus (GDM) diagnosed through oral glucose tolerance testing (OGTT). These women demonstrated higher weight, body mass index (BMI), waist circumference, family history of diabetes, FPG levels, and HbA1c levels during their initial booking compared to normoglycemic women. Through multiple regression analysis, it was found that early pregnancy FPG levels ≥95mg/dl (5.3mmol/l) independently correlated with abnormal glucose values at 24-28 weeks, even after adjusting for key covariates (adjusted odds ratio: 1.9; 95% confidence interval: 1.3-3.0, p < 0.001).

Therefore, the study concluded that most women with early pregnancy hyperglycemia achieved normal glucose levels by 24-28 weeks of pregnancy. However, it was found in HAPO study that, an FPG threshold of ≥95mg/dl was associated with an increased risk of adverse outcomes (adjusted odds ratio: 2.0). Therefore, it may be advisable to classify Indian women with this threshold as having abnormal glucose levels in early pregnancy.

1187-P. American Diabetes Association (ADA) 83rd Scientific Sessions, 23rd-26th June 2023, San Diego, CA