Association of first trimester fasting plasma glucose and gestational diabetes mellitus: A systematic review and meta-analysis

Vishnu Shivam; Vengojayaprassad Senathipathi

Authors

Vishnu Shivam Final year MBBS student, Coimbatore Medical College and Hospital.
Dr. Vengojayaprassad Senthipathi HOD, Department of Diabetology, Coimbatore medical College and Hospital, Coimbatore, India.

Keywords:

Gestational Diabetes mellitus, Fasting Plasma Glucose, First trimester, Pregnancy, Prevention of GDM

Abstract

International guidelines have addressed that identifying women at higher risk of GDM early in pregnancy is important as medical nutrition therapy as early as 15^th weeks of gestation has a positive impact in preventing the complications. Studies revealed that performing fasting plasma glucose (FPG) as a screening test is an ideal indicator to identify pregnant women at risk of Gestational Diabetes Mellitus (GDM) has a good efficacy, especially at low threshold, easy to measure, inexpensive and reproducible. Our main objective of this study is to systematically evaluate the available literatures on the association of First trimester FPG and GDM. A systematic search on MEDLINE database was carried out with MESH terms “Plasma Glucose” AND “First trimester” AND “Gestational Diabetes”. The study is conducted following the PRISMA checklist. On MEDLINE database search, 190 articles were identified. Out of these 13 were not in English language, 168 were excluded with reasons such as 11 reviews, 143 were not relevant to our study and 14 didn’t have sufficient data. Finally 9 studies were included in the meta-analysis. As there is a physiological drop in the FPG in early pregnancy, in conclusion this study reveals that First trimester FPG of 82-89 mg/dl (<92mg/dl) is statistically significant in predicting the risk of later development of GDM in pregnant women. Due to the limited study data availability in India, further multi-centric prospective research is needed to generalize and validate the results.

References

Vij, P., Jha, S., Gupta, S.K. et al. Comparison of DIPSI and IADPSG criteria for diagnosis of GDM: a study in a north Indian tertiary care center. Int J Diabetes Dev Ctries 35, 285–288 (2015). https://doi.org/10.1007/s13410-014-0244-5

Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015;131 Suppl 3:S173-S211. doi:10.1016/S0020-7292(15)30033-3

Li P, Lin S, Li L, Cui J, Zhou S, Fan J. First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes. Pak J Med Sci. 2019;35(1):95-100. doi:10.12669/pjms.35.1.216

Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Findik RB, Yilmaz C, Tasci Y. Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels [published correction appears in Arch Endocrinol Metab. 2020 Feb;64(1):97]. Arch Endocrinol Metab. 2019;63(2):121-127. doi:10.20945/2359-3997000000126

Hu M, Gu X, Niu Y, et al. Elevated serum triglyceride levels at first prenatal visit is associated with the development of gestational diabetes mellitus. Diabetes Metab Res Rev. 2022;38(2):e3491. doi:10.1002/dmrr.3491

Tong JN, Wu LL, Chen YX, et al. Fasting plasma glucose in the first trimester is related to gestational diabetes mellitus and adverse pregnancy outcomes. Endocrine. 2022;75(1):70-81. doi:10.1007/s12020-021-02831-w

Burlina S, Dalfrà MG, Belloni P, et al. Can the First Fasting Plasma Glucose Test in Pregnancy Predict Subsequent Gestational Complications?. Int J Endocrinol. 2022;2022:9633664. Published 2022 Apr 11. doi:10.1155/2022/96336648.

Tong JN, Chen YX, Guan XN, et al. Association between the cut-off value of the first trimester fasting plasma glucose level and gestational diabetes mellitus: a retrospective study from southern China. BMC Pregnancy Childbirth. 2022;22(1):540. Published 2022 Jul 4. doi:10.1186/s12884-022-04874-x

Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Eldem S, Hancerliogullari N, Engin-Ustun Y. Maternal serum glycosylated hemoglobin and fasting plasma glucose predicts gestational diabetes at the first trimester in Turkish women with a low-risk pregnancy and its relationship with fetal birth weight; a retrospective cohort study. J Matern Fetal Neonatal Med. 2021;34(12):1970-1977. doi:10.1080/14767058.2019.1651837

Rashidi H, Kalantari K, Shahbazian H, Nouhjah S. The relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes in Iran. Diabetes Metab Syndr. 2021;15(4):102193. doi:10.1016/j.dsx.2021.102193

Kang M, Zhang H, Zhang J, et al. A Novel Nomogram for Predicting Gestational Diabetes Mellitus During Early Pregnancy. Front Endocrinol (Lausanne). 2021;12:779210. Published 2021 Dec 9. doi:10.3389/fendo.2021.779210

Hao M, Lin L. Fasting plasma glucose and body mass index during the first trimester of pregnancy as predictors of gestational diabetes mellitus in a Chinese population. Endocr J. 2017;64(5):561-569. doi:10.1507/endocrj.EJ16-0359