Impact of maternal overweight/obesity and high fasting plasma glucose on adverse perinatal outcomes in early gestational diabetes mellitus

Aim

To elucidate risk factors associated with adverse perinatal outcomes in early-gestational diabetes mellitus (GDM).

Materials and Methods

A dataset of 385 early-GDM cases from a prospective cohort was analyzed. Early-GDM was diagnosed if one or more of the following criteria were met: fasting plasma glucose (PG) levels of 92–125 mg/dL, 1-h PG levels ≥180 mg/dL, and 2-h PG levels ≥153 mg/dL during a 75-g oral glucose tolerance test before 20 weeks of gestation. Multivariate analysis was used to examine associations between candidate risk factors and a composite outcome of maternal and neonatal adverse events.

Results

Pre-pregnancy overweight/obesity (pre-pregnancy body mass index [BMI] ≥25.0 kg/m²) was significantly associated with a higher risk of the composite outcome compared with normal weight (pre-pregnancy BMI of 18.5–24.9 kg/m²), an adjusted risk ratio (aRR) of 1.44 (95% confidence interval [CI]: 1.08–1.93), and an adjusted risk difference (aRD) of 13.6% (95% CI: 2.6–24.6%). Compared with fasting PG levels below 92 mg/dL, levels between 95 and 125 mg/dL were associated with a significantly higher risk of the composite outcome, with an aRR and aRD of 1.42 (95% CI: 1.01–1.99) and 12.9% (95% CI: 0.3–25.5%), respectively.

Conclusions

Early-GDM, combined with pre-pregnancy overweight/obesity and/or fasting PG levels of 95–125 mg/dL, is associated with a higher risk of adverse perinatal outcomes and should be prioritized for intervention.