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Objective Purpose of this study was to determine whether early identification of impaired glucose tolerance consistent with prediabetes among pregnant women with gestational diabetes mellitus (GDM) in the first trimester impacts maternal and neonatal outcomes. Study Design This was a retrospective cohort study of patients who were screened for pregestational diabetes in early pregnancy at a large academic tertiary care center from October 1, 2017, to January 31, 2021, and who subsequently developed GDM. Demographic and perinatal outcomes were compared among women with GDM with a positive early diabetes screen consistent with prediabetes to women who screened negative in the first trimester. Multivariable logistic regression was performed to adjust for baseline demographic differences. Results During the study period, 260 women screened had negative first trimester diabetes screening and subsequently developed GDM, while 696 screened positive for prediabetes and developed GDM. Women with prediabetes were more likely to require insulin treatment for their GDM compared with those that screened negative (79.5 vs. 45.4%, p < 0.001), while those who screened negative were more likely to take an oral medication of metformin or glyburide for GDM management than those with prediabetes (41.5 vs. 16.4%, p < 0.001). Infants born to mothers who screened positive for prediabetes were more likely to require neonatal intensive care unit (NICU) admission compared with those who screened negative even when adjusted for type of GDM treatment used (adjusted odds ratio [aOR] = 8.5, 95% confidence interval [CI]: 1.5–49.9). Conclusion Women identified as having early impaired glucose tolerance consistent with prediabetes that subsequently develop GDM are more likely to be prescribed insulin treatment and may be at increased risk of adverse neonatal outcomes leading to NICU admission than women with negative first trimester diabetes screening. Future studies should focus on whether different methods of early treatment and/or intervention improve perinatal outcomes. Key Points Prediabetes in early pregnancy is associated with higher rates of insulin treatment for GDM. Prediabetes in pregnancy increases the risk of developing GDM. Prediabetes in early pregnancy is associated with higher rates of NICU admission. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to characterize current diabetes screening practices in the first trimester of pregnancy in the United States, evaluate patient characteristics and risk factors associated with early diabetes screening, and compare perinatal outcomes by early diabetes screening. Methods: This was a retrospective cohort study of US medical claims data of persons diagnosed with a viable intrauterine pregnancy and who presented for care with private insurance before 14 weeks of gestation, without pre-existing pregestational diabetes, from the IBM MarketScan® database for the period January 1, 2016, to December 31, 2018. Univariate and multivariate analyses were used to evaluate perinatal outcomes. Results: A total of 400,588 pregnancies were identified as eligible for inclusion, with 18.0% of persons receiving early screening for diabetes. Of those with laboratory order claims, 53.1% underwent hemoglobin A1c testing, 30.0% underwent fasting glucose testing, and 16.9% underwent oral glucose tolerance testing. Compared with those who did not undergo early diabetes screening, those who did were more likely to be older; obese; having a history of gestational diabetes, chronic hypertension, polycystic ovarian syndrome, or hyperlipidemia; and having a family history of diabetes. In adjusted logistic regression, history of gestational diabetes (adjusted odds ratio 3.99; 95% confidence interval 3.73–4.26) had the strongest association with early diabetes screening. Adverse perinatal outcomes, including a higher rate of cesarean delivery, preterm delivery, preeclampsia, and gestational diabetes, occurred more frequently among women who underwent early diabetes screening. Conclusions: First-trimester early diabetes screening was mostly commonly performed by hemoglobin A1c evaluation, and persons who underwent early diabetes screening were more likely to experience adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

This study sought to compare test characteristics of hemoglobin A1c, oral glucose tolerance test and fasting plasma glucose for the development of gestational diabetes among women with prediabetes. Diabetes outcomes were compared by screening test used for prediabetes diagnosis among a retrospective cohort of pregnant patients between 2017–2021. During the study, 8132 patients received diabetes screening and 14.0% met criteria for prediabetes. By screening test, 75.1% were screened with hemoglobin A1c, 10.0% with fasting plasma glucose and 14.9% with a 75-g oral glucose tolerance test. Hemoglobin A1c had the highest positive predictive value (67.2%). Use of hemoglobin A1c was significantly more likely to identify women with GDM than oral glucose tolerance test (aOR 3.94, 95% CI 2.30–6.73). In this study cohort, hemoglobin A1c was able to identify patients that were more likely to develop GDM in an at-risk population. What is already known on this subject? Prediabetes is becoming more common in the general population; however little is known about prediabetes in pregnancy. Women with prediabetes in pregnancy appear to be at increased risk of developing gestational diabetes mellitus, however there is minimal information about various screening tests performance in pregnancy for detection of prediabetes and subsequent gestational diabetes. What do the results of this study add? The results of this study compare three commonly used screening tests for screening for diabetes. When identifying women with prediabetes, they are at increased risk for developing gestational diabetes mellitus if identified by hemoglobin A1c. What are the implications of these findings for clinical practice and/or further research? The clinical implication of this study is that women can be screened with hemoglobin A1c in early pregnancy for both overt diabetes, but also may be identified as high risk with prediabetes. Among women with prediabetes by hemoglobin A1c, they remain at high risk for developing gestational diabetes mellitus. [ABSTRACT FROM AUTHOR]