Subclinical Hyperglycemia in Pregnancy Linked to Higher Risk of Hypertensive Disorders: Study
USA: Researchers have found in a recent study that pregnant women with an abnormal glucose loading screening test and one abnormal value on the diagnostic oral glucose tolerance test (OGTT) have a higher risk of developing hypertensive disorders during pregnancy. These findings indicate that even mild or subclinical abnormalities in glucose metabolism may contribute to adverse pregnancy outcomes.
The study suggests that early identification and treatment of subclinical hyperglycemia during pregnancy may help reduce the risk of hypertensive disorders, highlighting the potential value of closer monitoring and intervention in this group of patients.
Published in the Journal of the American Heart Association, the study by Jacqueline Maya from the Diabetes Unit and Department of Medicine, Massachusetts General Hospital, Boston, USA, and colleagues evaluated whether untreated mild hyperglycemia below the diagnostic threshold for gestational diabetes is associated with hypertensive disorders of pregnancy.
The researchers retrospectively analyzed 41,484 pregnancies at a US academic medical center using a universal two-step gestational diabetes screening strategy. Pregnancies were classified as normal glucose tolerance, gestational glucose intolerance (0 or 1 abnormal OGTT value), or gestational diabetes (≥2 abnormal OGTT values), with gestational diabetes further categorized as treated or untreated.
The study led to the following findings:
- Of the 41,484 pregnancies analyzed, 84% had normal glucose tolerance, 12% had gestational glucose intolerance (GGI), and 3.5% had gestational diabetes.
- Women with gestational glucose intolerance had a 24% higher risk of developing hypertensive disorders of pregnancy compared with those with normal glucose tolerance (adjusted OR 1.24).
- The increased risk was mainly observed in women with one abnormal OGTT value (GGI-1), who had a 53% higher risk of hypertensive disorders of pregnancy (adjusted OR 1.53).
- The risk of hypertensive disorders in women with GGI-1 was comparable to that seen in women with untreated gestational diabetes (adjusted OR 1.76).
- Women with GGI-1 had a significantly higher risk of gestational hypertension (adjusted OR 1.66).
- Untreated gestational diabetes was also associated with an increased risk of gestational hypertension (adjusted OR 1.89).
- Treated gestational diabetes was not associated with an increased risk of gestational hypertension (adjusted OR 0.84), suggesting a potential benefit of glucose-lowering treatment.
- The risk of preeclampsia was elevated in women with GGI-1 as well as in those with both treated and untreated gestational diabetes (adjusted OR range 1.46–1.75).
The researchers acknowledged that the retrospective design, reliance on electronic health records, and potential unmeasured confounding were study limitations. They also did not account for low-dose aspirin use, as aspirin prophylaxis guidelines for high-risk pregnancies were introduced after the 1998–2016 study period.
The researchers concluded that untreated mild hyperglycemia, particularly in women with one abnormal OGTT value, is associated with an increased risk of hypertensive disorders of pregnancy. They called for randomized clinical trials to determine whether treating subclinical hyperglycemia can reduce the risk of gestational hypertension, preeclampsia, and other adverse maternal and pregnancy outcomes.
Reference: https://doi.org/10.1161/JAHA.125.04254
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