1377-P: Early Diagnosed Gestational Diabetes Mellitus: Initial Care Is Associated with Improved Prognosis when Fasting Plasma Glucose at Diagnosis Is ≥5.5 Mmol/l

Some guidelines recommend immediate care for women with fasting plasma glucose level (FPG) ≥5.1 mmol/L in early pregnancy (early-diagnosed gestational diabetes mellitus: eGDM). As diagnosis and care of hyperglycaemia can be delayed later in pregnancy, we assessed whether immediate vs. no immediate care for eGDM is associated with pregnancy outcomes. We retrospectively selected the women without known diabetes seen in our department (2012-2016) with a FPG level between 5.1 and 6.9 mmol/L before 22 weeks of gestation (WG) and separated them into two groups: (i) 255 who had immediate care; (ii) 268 who did not and performed an oral glucose tolerance test (OGTT) after 22 WG, with subsequent care if hyperglycaemia was present. We compared the occurrence of multiple outcomes including a composite adverse pregnancy outcome (large for gestational age infant, shoulder dystocia, preeclampsia). Among women without immediate care for eGDM, 134 had hyperglycemia after 22 WG. Women receiving immediate care were more likely than women with no immediate care to be insulin-treated (58.0 vs. 20.9%, p<0.00001) and had a lower gestational weight gain (8.6±5.4 vs. 10.8±6.1 kg, p<0.00001). After propensity score modeling and accounting for covariates, the rate of the composite outcome was similar in both groups (13.7 and 14.6% in women with and without immediate care respectively, p=0.87); however, when initial FPG was ≥5.5 mmol/L (n=134), the rates were respectively 8.0 and 17.7%, p=0.02. To conclude, immediate care of women with FPG ≥5.5 mmol/L in early pregnancy might improve pregnancy outcomes.