Fasting Hyperglycemia during Pregnancy: Outcomes According to Delay of Care-An Observational Study Including 471 Women

Some guidelines, as the French one, recommend to screen early in pregnancy for hyperglycaemia first-diagnosed during pregnancy and to immediately care for high-risk women with a fasting plasma glucose level (FPG) higher than 92 mg/dL before 22 weeks of gestation (WG) (eFHG: early fasting hyperglycaemia). To date, no randomized study has shown any benefit of such a strategy. Among the women without known diabetes who delivered in our French center (2012-2016), we compared in those with eFHG the incidence of a predefined composite outcome (preeclampsia or large for gestational age infant or shoulder dystocia or neonatal hypoglycemia) by tertiles of delay of care. We performed a sensitivity analysis in the women with an early FPG ≥100 mg/dL. We included 471 women (88% with risk factor(s); 456 early gestational diabetes mellitus; 15 overt diabetes) whose delay of care was by increasing tertiles: 3.5±1.5 (T1), 9.5±2.3 (T2) and 20.1±8.8 weeks (T3). FPG (101±17/99±9/97±9 mg/dL for T1/T2/T3 respectively), rates of obesity (45/28/30%), age ≥ 35 years (42/37/26%), insulin treatment during pregnancy (63/50/38%), gestational age at insulin onset (21.7±7.1/23.5±5.2/31.0±4.8 weeks of gestation) statistically differed across tertiles. The incidence of the composite outcome was similar across tertiles in the 471 women (15.8 vs. 11.4 vs. 15.5%; p=0.45) and also in the 136 women with early FPG ≥ 100 mg/dL (13.0 vs. 7.3 vs. 22.9%; p=0.12) with however more neonatal hypoglycemia for T3 in this subpopulation (0 vs. 0 vs. 9.3%; p<0.05).This observational study shows that a long delay of care of women with FPG ≥ 100 mg/dL early in pregnancy is associated with a high rate of neonatal hypoglycemia. This stands in favor of screening for this condition which should be immediately cared for. Adjustment of our results for propensity scores is ongoing. Disclosure E. Cosson: Board Member; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., LifeScan, Inc., Lilly Diabetes, Medtronic, Merck Sharp & Dohme Corp., Novartis France, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. Research Support; Self; Air Liquide, Lilly Diabetes, Novo Nordisk A/S, Roche Diagnostics France, Roche Foundation, Sanofi. E. Vicaut: Consultant; Self; Abbott, Bristol-Myers Squibb Company, Lilly Diabetes, Novartis France, Pfizer Inc., Pierre FABRE, Roche Pharma. D. Sandre Banon: None. C. Baudry: None. C. Cussac-Pillegand: None. P. Valensi: None. L. Carbillon: None. Funding Lilly France; Roche Diagnostics France