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

<b>Aims</b>: 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. <b>Methods</b>: 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&lt;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&lt;0.05. <b>Results</b>: 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&lt;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. <b>Conclusions</b>: Women with intermediate hyperglycaemia in early pregnancy are at an increased risk for adverse maternal-foetal outcomes, even with normal future OGTTs.

**研究目的**：通用的孕早期显性糖尿病筛查可检出中间性高血糖，该状态定义为空腹血浆葡萄糖（fasting plasma glucose, FPG）浓度介于5.1~6.9 mM之间。本研究旨在评估无妊娠糖尿病史的孕妇中，孕早期中间性高血糖与不良妊娠结局的关联。
**研究方法**：本研究为回顾性队列研究，于2013-2017年在中国上海妇产科医院开展。纳入所有孕早期空腹血浆葡萄糖（fasting plasma glucose, FPG）≤6.9 mM且完成75克口服葡萄糖耐量试验（oral glucose tolerance test, OGTT）的单胎妊娠孕妇，排除孕前已确诊糖尿病者，最终仅对口服葡萄糖耐量试验结果正常的受试者进行分析。比较空腹血浆葡萄糖＜5.1 mM组与中间性高血糖组的妊娠结局，主要结局指标为大于胎龄儿（large for gestational age, LGA）与首次剖宫产。采用多因素logistic回归分析，以P＜0.05作为差异具有统计学意义的判定标准。
**研究结果**：本研究共纳入24479例分娩病例，其中23450例（95.8%）在妊娠后期口服葡萄糖耐量试验结果正常，归为糖耐量正常组（normal glucose tolerance, NGT）。共计807例（3.4%）孕妇孕早期FPG介于5.1~6.9 mM之间。与孕早期FPG＜5.1 mM且糖耐量正常的对照组（n=20692）相比，中间性高血糖且糖耐量正常组（n=693）孕妇的年龄与体质量指数（BMI）更高，且大于胎龄儿、首次剖宫产、早产、子痫前期与新生儿窘迫的发生率均显著升高。在校正产妇年龄、体质量指数及其他潜在混杂因素后，首次剖宫产[调整后优势比（adjusted OR, AOR）1.24，95%置信区间（confidence interval, CI）1.05~1.45]、早产（AOR 1.75，95%CI 1.29~2.36）与新生儿窘迫（AOR 3.29，95%CI 1.57~6.89）的发生率仍显著升高。
**研究结论**：即使后续口服葡萄糖耐量试验结果正常，孕早期存在中间性高血糖的孕妇仍面临更高的母儿不良妊娠结局风险。