Evaluating glucose variability through OGTT in early pregnancy and its association with hypertensive disorders of pregnancy in non-diabetic pregnancies: a large-scale multi-center retrospective study

Sho Tano; Tomomi Kotani; Takafumi Ushida; Masato Yoshihara; Kenji Imai; Noriyuki Nakamura; Yukako Iitani; Yoshinori Moriyama; Ryo Emoto; Sawako Kato; Shigeru Yoshida; Mamoru Yamashita; Yasuyuki Kishigami; Hidenori Oguchi; Shigeyuki Matsui; Hiroaki Kajiyama

doi:10.1186/s13098-023-01103-z

Evaluating glucose variability through OGTT in early pregnancy and its association with hypertensive disorders of pregnancy in non-diabetic pregnancies: a large-scale multi-center retrospective study

Diabetol Metab Syndr. 2023 Jun 9;15(1):123. doi: 10.1186/s13098-023-01103-z.

Authors

Sho Tano^{1

2}, Tomomi Kotani^{3

4}, Takafumi Ushida¹, Masato Yoshihara¹, Kenji Imai¹, Noriyuki Nakamura¹, Yukako Iitani¹, Yoshinori Moriyama⁵, Ryo Emoto⁶, Sawako Kato⁷, Shigeru Yoshida⁸, Mamoru Yamashita⁸, Yasuyuki Kishigami², Hidenori Oguchi², Shigeyuki Matsui⁶, Hiroaki Kajiyama¹

Affiliations

¹ Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
² Department of Obstetrics, Perinatal Medical Center, TOYOTA Memorial Hospital, Nagoya, Aichi, Japan.
³ Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan. itoto@med.nagoya-u.ac.jp.
⁴ Division of Perinatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Achi, Japan. itoto@med.nagoya-u.ac.jp.
⁵ Department of Obstetrics and Gynecology, Fujita Health University School of Medicine, Nagoya, Aichi, Japan.
⁶ Department of Biostatistics, Nagoya University Hospital, Nagoya, Aichi, Japan.
⁷ Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
⁸ Kishokai Medical Corporation, Inazawa, Aichi, Japan.

Abstract

Background: Recent evidence suggests increased glucose variability (GV) causes endothelial dysfunction, a central pathology of hypertensive disorders of pregnancy (HDP). We aimed to investigate the association between GV in early pregnancy and subsequent HDP development among non-diabetes mellitus (DM) pregnancies.

Methods: This multicenter retrospective study used data from singleton pregnancies between 2009 and 2019. Among individuals who had 75 g-OGTT before 20 weeks of gestation, we evaluated GV by 75 g-OGTT parameters and examined its relationship with HDP development, defining an initial-increase from fasting-plasma glucose (PG) to 1-h-PG and subsequent-decrease from 1-h-PG to 2-h-PG.

Results: Approximately 3.0% pregnancies (802/26,995) had 75 g-OGTT before 20 weeks of gestation, and they had a higher prevalence of HDP (14.3% vs. 7.5%). The initial-increase was significantly associated with overall HDP (aOR 1.20, 95% CI 1.02-1.42), and the subsequent-decrease was associated with decreased and increased development of early-onset (EoHDP: aOR 0.56, 95% CI 0.38-0.82) and late-onset HDP (LoHDP: aOR 1.38, 95% CI 1.11-1.73), respectively.

Conclusions: A pattern of marked initial-increase and minor subsequent-decrease (i.e., sustained hyperglycemia) was associated with EoHDP. Contrarily, the pattern of marked initial-increase and subsequent-decrease (i.e., increased GV) was associated with LoHDP. This provides a new perspective for future study strategies.

Keywords: Glucose variability; Hypertensive disorders of pregnancy; OGTT.