Early prediabetes linked to cardiometabolic morbidity during pregnancy

Prediabetes in adolescent or young adult females has been linked to increased likelihood of gestational diabetes and adverse maternal and neonatal outcomes at first birth in a recent retrospective cohort study.

Researchers used data from the birth registry, hospital discharge, and New York City Department of Health A1C Registry and identified birthing individuals between 10 and 24 years with no history of diabetes and at least 1 preconception HbA_1c test in New York, New York, US.

The analysis included 14,302 individuals (mean age 22.10 years, 41.0 percent Hispanic) who met the eligibility criteria. Of these, 79.8 percent had normoglycaemia (HbA_1c <5.7 percent) and 20.2 percent had prediabetes (HbA_1c ≥5.7 percent to <6.5 percent) prior to their first pregnancy. Compared with those in the normoglycaemia group, those in the prediabetes group were more likely to have obesity (29.4 vs 15.7 percent).

The primary outcome of gestational diabetes at first birth occurred more frequently among participants with preconception prediabetes vs normoglycaemia (adjusted relative risk [aRR], 2.21, 95 percent confidence interval [CI], 1.91–2.56).

Preconception prediabetes was associated with a small but significant increase in the risk of a hypertensive disorder of pregnancy (aRR, 1.18, 95 percent CI, 1.03–1.35) and preterm delivery (aRR, 1.18, 95 percent CI, 1.02–1.37), as well as a nonsignificant increase in the risk of caesarean delivery (aRR, 1.09, 95 percent CI, 0.99–1.20) and macrosomia (aRR, 1.13, 95 percent CI, 0.93–1.37).

Receiver operating curve analysis showed that the optimal HbA_1c threshold to identify gestational diabetes among adolescents and young adults was 5.6 percent. This threshold did not vary by obesity status but was slightly lower among Hispanic individuals (HbA_1c of 5.5 percent).

The findings highlight the importance of efforts to optimize cardiometabolic health before pregnancy in order to mitigate excess maternal risk.