Neuro Endocrinol Lett. 2026 Mar 24;47(1). Online ahead of print.
ABSTRACT
OBJECTIVE: To evaluate first-trimester FBG category, pre-pregnancy BMI, and serial FBG trajectory as stratified predictors of GDM in a routine-care antenatal cohort.
METHODS: Retrospective cohort of 771 women delivering at a single Chinese tertiary hospital (January-June 2013), with first-trimester FBG (<12 weeks) and 75-g OGTT at 24-28 weeks (Chinese IADPSG thresholds). GDM was diagnosed in 158 women (20.5%). Associations were analyzed by chi-square and Fisher’s Exact Test (SPSS v19.0); all estimates are unadjusted.
RESULTS: First-trimester FBG supported a two-tier, not three-tier, risk classification: GDM incidence in the ≤4.7 and 4.7-5.1 mmol/L strata was statistically indistinguishable (14.2% vs. 18.0%; Bonferroni-corrected p=0.188), while both were significantly lower than the ≥5.1 mmol/L stratum (45.9%; both P<0.001; overall χ²=58.835, p<0.01). The sole statistically supported triage cut-point is FBG ≥5.1 mmol/L. Non-decreasing FBG trajectory was the strongest predictor: 100% GDM incidence in the FBG ≥5.1 non-decreased subgroup (n=29; 95% CI: 88-100%; p<0.01) and 54.9% (95% CI: 43-67%) versus 4.2% in the FBG 4.7-5.1 stratum (n=71 vs. 190; p<0.01), yielding NPV 95.8% for a decreasing trajectory in this intermediate-risk group. BMI ≥24 kg/m² independently elevated GDM risk in women with FBG <5.1 mmol/L (p<0.01) but not in the FBG ≥5.1 stratum (p=0.075, n=34).
CONCLUSION: Non-decreasing FBG trajectory identifies high-risk subgroups missed by a single threshold, using measurements already collected in routine prenatal care. FBG ≥5.1 mmol/L alone carries a 54.1% false-positive rate; the trajectory rule substantially refines this triage. RCTs are needed to assess early intervention benefit.
PMID:41915924
