First Trimester Fasting Hyperglycemia and Adverse Pregnancy Outcomes

  1. SHLOMIT RISKIN-MASHIAH, MD (shlomitri{at},
  3. AMIT DAMTI, MD1 and
  1. Departement of Obstetrics and Gynecology1, The Lady Davis Carmel Medical Center, Rappaport Faculty of Medicine, Technion, Haifa, Israel


    Objective: The HAPO study found strong associations between higher levels of maternal glucose at 24-32 weeks, within what is currently considered normoglycemia and adverse pregnancy outcomes. Our aim was to evaluate the associations between first trimester fasting plasma glucose level and adverse pregnancy outcomes.

    Research Design and Methods: Charts of all patients who delivered at our hospital between 6/2001 and 6/2006 were reviewed. Only subjects with singleton pregnancy and a recorded first trimester fasting glucose level were included. Women with pregestational diabetes, fasting glucose level>105mg/dL or delivery<24 weeks were excluded. Fasting glucose levels were analyzed in seven categories, similar to the HAPO study. The main outcomes were development of gestational diabetes mellitus (GDM), large for gestational age (LGA) neonates and/or macrosomia and primary cesarean section. Multivariate logistic regression analysis was used; significance<0.05.

    Results: 6129 women had fasting glucose test at median of 9.5 weeks. There were strong graded associations between fasting glucose level and primary outcomes: the frequency of GDM development increased from 1.0% in the lowest glucose category to 11.7% in the highest, adjusted odds ratio [AOR], 11.92; 95% confidence interval [CI], 5.39-26.37. The frequency of LGA and/or macrosomia increased from 7.9% to 19.4%, AOR 2.82 (95%CI 1.67-4.76). Primary cesarean section rate increased from 12.7% to 20.0%, AOR 1.94 (95%CI 1.11-3.41).

    Conclusion: Higher first trimester fasting glucose levels, within what is currently considered a nondiabetic range, increase the risk of adverse pregnancy outcomes. Early detection and treatment of women at high risk for these complications might improve pregnancy outcome.


      • Received April 9, 2009.
      • Accepted June 15, 2009.