A study suggests that measuring fasting plasma glucose (FPG) and triglyceride (TG) levels early in pregnancy can identify women at high risk of gestational diabetes mellitus (GDM).

Receiver operating characteristic analysis showed that at a cutoff of 3.94 mmol/L, early pregnancy FPG was 91.7 percent sensitive and 74.2 percent specific for predicting GDM. Meanwhile, early TG values had a 75 percent sensitivity and 77.1 percent specificity at a 0.945-mmol/L cutoff. [Cureus 2024;16:e58245]

Both FPG and TG were significantly associated with GDM. The odds of GDM were threefold higher among mothers who had early pregnancy FPG level of >3.45 mmol/L (odds ratio [OR], 3.81, 95 percent confidence interval [CI], 0.45?30.0;p<0.05) and those who had early pregnancy TG level of >0.945 mmol/L (OR, 3.2, 95 percent CI, 0.3?28.0; p<0.05).

Lead study author Dr Jeyarajah Rajeevan from the Jaffna Teaching Hospital in Jaffna, Sri Lanka, said the findings indicate that early pregnancy FPG and TG levels have the potential to serve as markers for predicting GDM. Rajeevan presented the results of the study at RCOG 2024.

“A big variation in confidence interval for TG and FPG may be due to the minimum requirement of sample size used,” he added.

Between FPG and TG, the former was a better predictor of GDM, Rajeevan noted. He pointed out that when looking at the values at the first visit (8?12 weeks of amenorrhea), the ORs for GDM were 3.8 with FPG and 3.4 with TG. “This concurs with prior research, highlighting early pregnancy FPG as the most accurate predictor for GDM. Using the IADPSG* criteria, the OR for GDM with FPG was 10.03, with an area under the curve of 0.83 (95 percent CI, 0.77?0.90).” [Reprod Sci 2015;22:712-717]

As for TG, the association between early pregnancy lipid profile abnormality and the risk of GDM is consistent with dyslipidemia in obesity, which is characterized by heightened cholesterol, TG, and low-density lipoprotein (LDL) as well as decreased high-density lipoprotein (HDL) cholesterol levels, according to Rajeevan. However, the exact mechanisms underlying the association remain unclear.

“Some studies have found that accumulation of lipids in excessive amounts may cause increased oxidative stress, which correlates with insulin resistance, whereas other studies have described that abnormality in lipid metabolism can lead to the direct destruction of the function of ?? cells of the pancreas,” he said. [World J Diabetes 2015;6:456-480; Adv Clin Chem 2011;55:133-153]

Study details

The analysis included 172 pregnant women (mean age 29.84 years, mean BMI 23.08 kg/m², 34.9 percent had obesity, 16.3 percent had a family history of diabetes). The prevalence of GDM was 16.9 percent, and among mothers with GDM, 57.14 percent had obesity.

Mean FPG values increased with advancing pregnancy, and this was true for the GDM group (from 4.92 mmol/L at first visit to 5.62 at 26?28 weeks). For the lipid profile, 30 percent of women had increased levels of cholesterol, 12.5 percent had increased levels of TG, 42 percent had increased LDL cholesterol, and 63.2 percent had reduced HDL cholesterol levels. Mean TG levels were higher in the GDM than in the non-GDM group (1.31 vs 1.19 mmol/L).

*International Association of Diabetes and Pregnancy Study Groups