First-trimester fasting plasma glucose as a predictor of subsequent gestational diabetes mellitus and adverse fetomaternal outcomes: A systematic review and meta-analysis

IF 4.3 Q1 ENDOCRINOLOGY & METABOLISM
Saptarshi Bhattacharya , Lakshmi Nagendra , Deep Dutta , Sunetra Mondal , Sowrabha Bhat , John Michael Raj , Hiya Boro , A.B.M. Kamrul-Hasan , Sanjay Kalra
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引用次数: 0

Abstract

Background

The implication of intermediately elevated fasting plasma glucose (FPG) in the first trimester of pregnancy is uncertain.

Purpose

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.

Data sources

Databases were searched for articles published from 2010 onwards for studies examining the relationship between first-trimester FPG and adverse fetomaternal outcomes.

Study selection

A total of sixteen studies involving 115,899 pregnancies satisfied the inclusion criteria.

Data extraction and data synthesis

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.

Limitations

Only one study reported outcomes at first-trimester FPG of 6.1 mmol/L (110 mg/dL), and hence was not analyzed.

Conclusion

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.

首胎空腹血浆葡萄糖可预测妊娠糖尿病和不良胎产结局:系统回顾和荟萃分析
背景妊娠头三个月空腹血浆葡萄糖(FPG)间歇性升高的影响尚不确定。目的荟萃分析的主要结果是分析妊娠头三个月 FPG 间歇性升高是否可预测 24-28 周 GDM 的发生。次要结果是确定常用的 FPG 临界值 5.1 毫摩尔/升(92 毫克/分升)、5.6 毫摩尔/升(100 毫克/分升)和 6.1 毫摩尔/升(110 毫克/分升)是否与不良妊娠事件相关。数据来源在数据库中搜索了 2010 年以来发表的文章,以了解研究首胎 FPG 与不良胎产结局之间关系的研究。研究选择符合纳入标准的共有 16 项研究,涉及 115,899 例妊娠。数据提取和数据综合发生 GDM 的妇女的首胎 FPG 显著高于未发生 GDM 的妇女[MD 0.29 mmoL/l (5 mg/dL); 95 % CI: 0.21-0.38; P < 0.00001]。首胎 FPG ≥5.1 mmol/L (92 mg/dL) 可预测 24-28 周发生 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]、妊娠高血压[RR1.47(95%CI:1.20-1.79);P = 0.0001]、胎龄过大(LGA)[RR 1.32(95%CI:1.13-1.54);P = 0.0004]和巨大儿[RR1.29(95%CI:1.15-1.44);P <;0.001]。然而,在上述临界值下,早产率、下段剖宫产率(LSCS)、小胎龄率(SGA)和新生儿低血糖率并没有显著增加。首胎 FPG≥5.6 mmol/L (100 mg/dL) 与巨大儿[RR1.47(95%CI:1.22-1.79);P < 0.0001]、LGA [RR 1.43(95%CI:1.24-1.65);P < 0.00001]和早产[RR1.51(95%CI:1.15-1.98);P = 0.局限性仅有一项研究报告了初产妇 FPG 为 6.1 mmol/L (110 mg/dL) 时的结果,因此未进行分析。妊娠前三个月 FPG 临界值为 5.1 mmol/L(92 mg/dL)和 5.6 mmol/L(100 mg/dL)可预测多种不良妊娠结局。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
22.90
自引率
2.00%
发文量
248
审稿时长
51 days
期刊介绍: Diabetes and Metabolic Syndrome: Clinical Research and Reviews is the official journal of DiabetesIndia. It aims to provide a global platform for healthcare professionals, diabetes educators, and other stakeholders to submit their research on diabetes care. Types of Publications: Diabetes and Metabolic Syndrome: Clinical Research and Reviews publishes peer-reviewed original articles, reviews, short communications, case reports, letters to the Editor, and expert comments. Reviews and mini-reviews are particularly welcomed for areas within endocrinology undergoing rapid changes.
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