Maternal hyperglycemia in early pregnancy and its association with adverse feto-maternal outcomes: a prospective observational study from a tertiary care center

Abstract

Background: Hyperglycemia during pregnancy, including Gestational Diabetes Mellitus (GDM) and undiagnosed pre-gestational diabetes, is a growing global health concern. While GDM screening is standard, the impact of mild hyperglycemia identified early in the first or early second trimester (prior to standard screening) on feto-maternal outcomes remains an area of active investigation. This study aimed to determine the prevalence of early maternal hyperglycemia and assess its association with a range of adverse feto-maternal outcomes in a tertiary care setting. Methods: This was a single-center, prospective observational cohort study conducted at Kanachur Institute of Medical Sciences, Mangalore, from January 2024 to December 2024. A total of 312 pregnant women presenting for their first antenatal visit before 24 weeks of gestation were enrolled. Early hyperglycemia was defined as a random plasma glucose (RPG) mg/dL or a fasting plasma glucose (FPG) mg/dL (or one abnormal value on a 75-g Oral Glucose Tolerance Test (OGTT)) performed at enrollment. Participants were followed until delivery, and data on maternal complications (pre-eclampsia, preterm birth, cesarean section) and neonatal outcomes (macrosomia, hypoglycemia, NICU admission) were collected. Statistical analysis included tests, Student's -tests, and a multivariate logistic regression model to adjust for confounding factors. Results: Of the 312 participants, 48 (15.38%) were diagnosed with early maternal hyperglycemia. The hyperglycemia group showed a significantly higher incidence of primary cesarean delivery (35.4% vs. 19.3%;), pre-eclampsia (14.6% vs. 5.7%;), and preterm birth (12.5% vs. 4.9%;) compared to the normoglycemic group. Neonates born to mothers with early hyperglycemia had higher rates of macrosomia (18.8% vs. 6.8%;) and NICU admission (20.8% vs. 8.7%;). Multivariate analysis confirmed that early maternal hyperglycemia was an independent risk factor for adverse feto-maternal outcomes (Adjusted Odds Ratio (AOR) 2.15, 95% CI 1.15-4.03;). Conclusion: Early maternal hyperglycemia, even before the typical window for GDM screening, is significantly associated with increased risks of adverse feto-maternal outcomes. These findings support the need for heightened vigilance and potentially earlier, standardized screening for hyperglycemia in the antenatal period to improve perinatal care and long-term health.