TY - JOUR
T1 - Relationship Between Early-Pregnancy Glycemia and Adverse Outcomes
T2 - Findings From the TOBOGM Study
AU - Sweeting, Arianne
AU - Enticott, Joanne
AU - Immanuel, Jincy
AU - Hague, William M.
AU - Teede, Helena
AU - Nolan, Christopher J.
AU - Peek, Michael J.
AU - Flack, Jeff R.
AU - McLean, Mark
AU - Wong, Vincent W.
AU - Hibbert, Emily J.
AU - Kautzky-Willer, Alexandra
AU - Harreiter, J€Urgen
AU - Backman, Helena
AU - Gianatti, Emily
AU - Mohan, Viswanathan
AU - Cheung, N. Wah
AU - Simmons, David
N1 - Publisher Copyright:
© 2024 by the American Diabetes Association.
PY - 2024/12
Y1 - 2024/12
N2 - We evaluated associations between early-pregnancy oral glucose tolerance test (OGTT) glucose and complications in the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) cohort to inform prognostic OGTT thresholds. RESEARCH DESIGN AND METHODS Individuals with risk factors for hyperglycemia were recruited for an international, multicenter, randomized controlled gestational diabetes mellitus (GDM) (World Health Organization 2013 criteria) treatment trial. A 2-h 75-g OGTT was performed at <20 weeks’ gestation. Individuals with early treated hyperglycemia in pregnancy were excluded fromthe primary analysis. Early OGTT glucose concentrations were analyzed continuously and in glycemic categories (normal, low band, and high band). RESULTS Overall, 3,645 individuals had an OGTT at (mean ± SD) 15.6 ± 2.5 weeks. For each 1-SD increase in fasting, 1-h, and 2-h glucose values, there were continuous positive associations with late GDM: adjusted odds ratio (aOR) 2.04 (95% CI 1.82-2.27), 3.05 (2.72-3.43), and 2.21 (1.99-2.45), respectively. There were continuous positive associations between 1-h and 2-h glucose and the perinatal composite (birth <37 + 0 weeks, birth trauma, birth weight $4,500 g, respiratory distress, phototherapy requirement, stillbirth/neonatal death, and shoulder dystocia), with aOR 1.15 (95% CI 1.04-1.26) and 1.14 (1.04-1.25), respectively, and with large-for-gestational-age offspring, with aOR 1.18 (1.06-1.31) and 1.26 (1.01-1.25), respectively. Significant associations were also observed between 1-h glucose and cesarean section and between fasting and 2-h glucose and neonatal hypoglycemia. In categorical analysis, only the high-band 1-h glucose ($10.6mmol/L [191mg/dL]) predicted the perinatal composite. CONCLUSIONS There is a continuous positive association between early-pregnancy OGTT glucose and complications. In individuals with hyperglycemia risk factors, only the high-glycemic-band 1-h glucose corresponded to increased risk of major perinatal complications.
AB - We evaluated associations between early-pregnancy oral glucose tolerance test (OGTT) glucose and complications in the Treatment of Booking Gestational Diabetes Mellitus (TOBOGM) cohort to inform prognostic OGTT thresholds. RESEARCH DESIGN AND METHODS Individuals with risk factors for hyperglycemia were recruited for an international, multicenter, randomized controlled gestational diabetes mellitus (GDM) (World Health Organization 2013 criteria) treatment trial. A 2-h 75-g OGTT was performed at <20 weeks’ gestation. Individuals with early treated hyperglycemia in pregnancy were excluded fromthe primary analysis. Early OGTT glucose concentrations were analyzed continuously and in glycemic categories (normal, low band, and high band). RESULTS Overall, 3,645 individuals had an OGTT at (mean ± SD) 15.6 ± 2.5 weeks. For each 1-SD increase in fasting, 1-h, and 2-h glucose values, there were continuous positive associations with late GDM: adjusted odds ratio (aOR) 2.04 (95% CI 1.82-2.27), 3.05 (2.72-3.43), and 2.21 (1.99-2.45), respectively. There were continuous positive associations between 1-h and 2-h glucose and the perinatal composite (birth <37 + 0 weeks, birth trauma, birth weight $4,500 g, respiratory distress, phototherapy requirement, stillbirth/neonatal death, and shoulder dystocia), with aOR 1.15 (95% CI 1.04-1.26) and 1.14 (1.04-1.25), respectively, and with large-for-gestational-age offspring, with aOR 1.18 (1.06-1.31) and 1.26 (1.01-1.25), respectively. Significant associations were also observed between 1-h glucose and cesarean section and between fasting and 2-h glucose and neonatal hypoglycemia. In categorical analysis, only the high-band 1-h glucose ($10.6mmol/L [191mg/dL]) predicted the perinatal composite. CONCLUSIONS There is a continuous positive association between early-pregnancy OGTT glucose and complications. In individuals with hyperglycemia risk factors, only the high-glycemic-band 1-h glucose corresponded to increased risk of major perinatal complications.
UR - http://www.scopus.com/inward/record.url?scp=85210682878&partnerID=8YFLogxK
U2 - 10.2337/dc23-2214
DO - 10.2337/dc23-2214
M3 - Article
C2 - 39083673
AN - SCOPUS:85210682878
SN - 1935-5548
VL - 47
SP - 2085
EP - 2092
JO - Diabetes Care
JF - Diabetes Care
IS - 12
ER -