Effect of treating mild hyperglycemia in early pregnancy on maternal and neonatal clinical outcomes.

Abstract

Background: Maternal hyperglycemia during pregnancy can lead to adverse maternal and neonatal outcomes. Although early treatment is recommended, several randomized controlled trials did not show significant benefits from early intensified treatment, meaning that the benefits of treatment for early abnormal glucose remain unclear. Therefore, in this study, we aimed to evaluate the effect of medical nutritional treatment during early pregnancy of women with mild hyperglycemia on maternal and neonatal clinical outcomes.

Methods: Women in this retrospective cohort study who had mild hyperglycemia (6.1 mmol/L > fasting plasma glucose ≥ 5.1 mmol/L and hemoglobin A1c < 5.9%) in the first trimester and a diagnosis of gestational diabetes mellitus after an oral glucose tolerance test at 24-28 weeks were divided into control and treatment groups depending on whether they receive medical nutritional treatment during early pregnancy. We compared the maternal and neonatal outcomes.

Results: A total of 344 women were enrolled, and 309 participants were available for analysis (170 in the treatment group and 139 in the control group). Compared with the control group, fewer women in the treatment group had cesarean deliveries (44.7% vs. 61.2%; relative risk [RR], 0.70; 95% confidence interval [CI], 0.54-0.90, P = 0.004) and required insulin therapy (2.9% vs. 8.6%; RR, 0.94; 95% CI, 0.88-0.99, P = 0.004). Women in the treatment group exhibited lower glucose levels and weight gain. Newborns in the treatment group had a higher gestational age at birth than those in the control group (39.1 [39.5, 40.0] vs. 38.8 [38.1, 39.5], P = 0.005). No significant differences were observed in other maternal and neonatal outcomes.

Conclusions: Immediate medical nutritional treatment for pregnant women with mild hyperglycemia during early pregnancy seems to lower the incidence of cesarean delivery and insulin therapy during pregnancy than no treatment. However, no significant differences were observed in neonatal outcomes, except for a higher gestational age at birth of the newborns in the treatment group.

Clinical trial number: Not applicable. This is an observational study.