(1275) First-trimester fasting glucose correlates with long-term maternal diabetes mellitus and cardiovascular complications

To examine the association between first‑trimester fasting glucose (FG) and subsequent maternal diabetes mellitus (DM) and cardiovascular disease (CVD).

Study Design:

We performed a retrospective review of electronic medical records from a large healthcare provider, identifying deliveries since 2012. Pregnancies were included if first-trimester FG was documented, excluding those with preexisting DM or CVD. Only the earliest delivery per individual was included. Propensity score-weighted Kaplan-Meier analysis was used to estimate cumulative incidence of maternal long-term outcomes by FG category, with censoring when follow-up data were no longer available. A subanalysis was conducted among those with more than one elevated first trimester FG (“persistent”). The primary outcome, DM and/or CVD diagnoses, (ICD-10 codes) within five years postpartum, was compared according to the calculated 95th percentile (2SD) FG cutoff.

Results:

Derived from the 202,960 people who met the inclusion criteria, a first-trimester FG level of 100 mg/dL was identified as the 95th percentile, with 10,759 people having a first-trimester FG≥100mg/dL, and 192,201 having an FG below this cutoff. Those with an FG≥100 mg/dL were older and had a higher BMI (31.0±5.7 vs. 29.8±5.5, p< 0.001 and 28.2±6.7 vs. 25.05±14.9 kg/m² p< 0.0001, respectively). At five years postpartum (n=159,148), compared to those with a FG < 95^th percentile, they had higher rates of HbA1C >5.7% [16.9% (n=1,509) vs. 3.3% (n=6,552), p< 0.001 and newly diagnosed DM and CVD [2.4% (n=203) vs. 0.6% (n=984), p< 0.001 and 0.9% (n=78) vs. 0.6% (n=913), p< 0.001, respectively). These findings are further supported by the subanalysis, which showed a significantly higher risk of newly diagnosed DM in the persistent elevated-FG group (Figure 1).

Conclusion:

A first-trimester fasting glucose level ≥100mg/dL is associated with an increased risk of developing diabetes mellitus and cardiovascular disease later in life. In these patients, postpartum care should focus on monitoring and patient education aiming to mitigate these risks.