1404-P: 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.