Fasting glycemia at the first prenatal visit and pregnancy outcomes in Russian women

BACKGROUND: The aim of this study was to evaluate the associations between fasting glycemia (FG) at the first prenatal visit and adverse pregnancy outcomes. METHODS: Medical records of 1584 pregnant women with a recorded level of FG < 7 mmol/L before 24 weeks of gestation and delivery after 24 weeks were examined 823 of them underwent oral glucose tolerance test (OGTT) at 24-32 weeks of pregnancy. FG values were devided into five groups starting with < 4.1 mmol/L as the first group; with subsequent increases of 0.5 mmol/L between groups and > 5.6 mmol/L as the last group. The main outcomes were gestational diabetes mellitus (GDM) development, macrosomia, primary cesarean delivery, shoulder dystocia or birth injury. RESULTS: With increasing FG levels at first prenatal visit, the frequency of GDM (among women who underwent OGTT) increased from 18.3% in the lowest category to 44.4% in the highest (odds ratio (OR) 2.94; 95% confidence interval [CI]: 1.39-6.19) and the frequency of hyperbilinibinemia increased from 4.5 to 18% respectively (OR 4.7; 95% CI: 1.8-12.5). After adjustment for maternal age and BMI, only the highest glucose category (5.6 < FG < 7 mmol/L) was significantly associated with the increased risk of the above mentioned outcomes. The frequency of shoulder dystocia/birth injury (OR 24.5; 95% CI: 2.8-214.8) and preeclampsia (OR 2.7; 95% CI: 1.2-5.9) was increased in the highest glucose category compared to the intermediary categories. CONCLUSIONS: Only the highest glucose category (5.6 < FG < 7 mmol/L) at the first prenatal visit was strongly associated with some adverse pregnancy outcomes.