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

Aim: The aim of the study was to evaluate the associations between fasting glycemia (FG) at the first prenatal visit and adverse pregnancy outcomes.

Materials And Methods: Medical records of 1,584 pregnant women with a recorded level of FG before 24 weeks of gestation were examined. Subjects with pregestational diabetes or delivery before 24 weeks were excluded. 823 women 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 hyperbilirubinemia 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 of 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.

Conclusion: Only the highest glucose category (5.6< FG< 7 mmol/L) at the first prenatal visit was strongly associated with some adverse pregnancy outcomes.