Impaired Fasting Glucose in Pregnancy: Improved Perinatal Outcomes with Active Glycemic Management

Abstract

Objective This study aimed to assess the association between active glycemic management and large for gestational age (LGA) neonates and cesarean delivery (CD) among pregnant women with impaired fasting glucose (IFG).

Study Design Retrospective cohort study using electronic health record data of women with IFG who delivered at the Kaiser Permanente Northern California from 2012 to 2017. IFG was defined as isolated fasting glucose ≥95 mg/dL. Women with gestational diabetes mellitus (GDM) or in whom GDM could not be ruled out were excluded. Baseline and treatment characteristics, and pregnancy outcomes were compared among women with IFG who participated in telephonic home glucose monitoring and glycemic management through a centralized standardized program (participants) with those who did not participate (nonparticipants). The relative risks (RRs) of perinatal complications associated with participation versus nonparticipation were estimated with Poisson's regression models.

Results We identified 1,584 women meeting inclusion criteria of whom 1,151 (72.7%) were participants and 433 (27.3%) were nonparticipants. There were no differences between groups in baseline characteristics or comorbidities, except for higher mean levels of fasting glucose (FG) at the time of IFG diagnosis in participants than in nonparticipants (98.9 vs. 98.0 mg/dL, p = 0.01). Participants received hypoglycemic medications more frequently than nonparticipants (68.2 vs. 0.9%, p < 0.01). The rate of LGA was significantly lower in participants compared with nonparticipants (19.1 vs. 25.0%, p = 0.01). After adjusting for age, race/ethnicity, education, body mass index, and level of FG impairment, the RR for LGA for participants compared with nonparticipants was 0.68, 95% CI: 0.55–0.84. The risk of CD did not differ significantly by participation status, in unadjusted or adjusted analyses.

Conclusion Active standardized glycemic management was associated with a decreased risk of LGA for women with IFG. This finding supports an active glycemic management strategy for patients with IFG during pregnancy to reduce the risk of LGA, similar to GDM management.

Key Points

• Pregnant women with IFG have increased rates of LGA.

• Active management of IFG is associated with a decreased LGA.

• Treatment of IFG like GDM may improve perinatal outcomes.

Keywords

gestational diabetes - glycemic management - impaired fasting glucose - large for gestational age

Condensation

Active standardized glycemic management was associated with a decreased risk of large for gestational age neonates for pregnant women with impaired fasting glucose.

Note

The abstract was presented as a poster presentation at SMFM's 2021 Annual Pregnancy Meeting virtually occurring January 25–30, 2021. All authors were involved in the formulation of the research question, choice of study design, data collection, analysis, and decision to publish.

Publication History

Received: 25 July 2021

Accepted: 21 June 2022

Accepted Manuscript online:
24 June 2022

Article published online:
02 September 2022

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