Poster Presentation Australian Diabetes in Pregnancy Society 2018

SHIFT – Significance of mild Hyperglycaemia In First Trimester pregnancy (#109)

Alison Gebuehr 1 , Emma Croker 1 , Margaret Harris 2 , Andrew Woods 3 , Katie Wynne 1 2 4
  1. Department of Diabetes & Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
  2. School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
  3. Department of Obstetrics and Gynaecology, John Hunter Hospital, Newcastle, NSW, Australia
  4. Hunter Medical Research Institute, Newcastle, NSW, Australia


Glucose testing is performed in early pregnancy to identify women with undiagnosed overt diabetes.1,2 Glucose levels considered diagnostic of gestational diabetes (GDM) at 24-28 weeks gestation may be present in the first trimester, but it is unclear if this predicts GDM, or if treatment of these women improves materno-foetal outcomes.3,4,5,6


A prospective observational audit (January to December 2017) was performed of women referred to our service with fasting plasma glucose (FPG) 5.1-6.9mmol/l in the first trimester. Women with pre-existing diabetes, overt diabetes, twin pregnancy, and those taking diabetes medication were excluded. Demographic data was collected. Women were categorised based on FPG as having lower glucose (LG: 5.1-5.5mmol/l) or higher glucose (HG: 5.6-6.9mmol/l) levels. Pre-specified maternal and foetal outcomes were recorded.


Twenty-six women were included in the analysis (LG n=17; HG n=9). Women in the HG group were more likely to have BMI>30kg/m2 (89% vs 41% p=0.04). A subsequent diagnosis of GDM was made in 78% HG women and 59% LG women in 2nd/3rd trimester; higher than local population prevalence of (17%).

The neonates of HG women were of similar weight (3419±454gm) to those of LG women (3683± 440gm; p=0.16). Average birth-weight (3592±462gm) was higher when compared to neonates born to women with treated T2DM in our unit (n=49 3077± 954gm; p=0.01).7

Macrosomia (birth-weight ≥4kg) did not occur in HG neonates, but was present in 24% of LG neonates. Adverse neonatal outcomes (composite of neonatal intensive care admission, respiratory distress or requirement of continuous positive airway pressure and shoulder dystocia) occurred in 22% HG group and 53% LG group (p=0.42).


This data suggests that early fasting hyperglycaemia may not be a benign condition. A high proportion of women went on to develop GDM. Neonates had a higher birth-weight when compared to women with treated T2DM; adverse outcomes were seen frequently in both HG and LG women. Further studies are needed to guide the management of these women.6

  1. 1. Nankervis A, McIntyre HD, Moses R, et al. ADIPS consensus guidelines for the testing and diagnosis of gestational diabetes mellitus in Australia and New Zealand. Nov 2014.
  2. 2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682.
  3. 3. Zhu W. W., Yang H. X., Wei Y. M., et al. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China. Diabetes Care. 2013;36(3):586–590. doi: 10.2337/dc12-1157
  4. 4. Sweeting A. N., Ross G. P., Hyett J., et al. Gestational diabetes mellitus in early pregnancy: evidence for poor pregnancy outcomes despite treatment. Diabetes Care. 2016;39(1):75–81. doi: 10.2337/dc15-0433.
  5. 5. Corrado F., D'Anna R., Cannata M. L., Interdonato M. L., Pintaudi B., Di Benedetto A. Correspondence between first-trimester fasting glycaemia, and oral glucose tolerance test in gestational diabetes diagnosis. Diabetes & Metabolism. 2012;38(5):458–461. doi: 10.1016/j.diabet.2012.03.006
  6. 6. Simmons, D., Hague, W., Teede, H., Cheung, N., Hibbert, E., Nolan, C., Peek, M., Girosi, F., Cowell, C., Wong, V., Flack, J., McLean, M., Dalal, R., Robertson, A. and Rajagopal, R. (2018). Hyperglycaemia in early pregnancy: the Treatment of Booking Gestational diabetes Mellitus (TOBOGM) study. A randomised controlled trial. [online] Available at: [Accessed 29 May 2018].
  7. 7. Joshi, T., Mcelduff, S., Lewis, M. and Wynne, K. (2015). Poor neonatal outcomes in mothers with T1 diabetes compared to T2 diabetes. In: ADIPS ASM. [online] .Oral presentation and Poster. Available at: