Combined predictive value of early pregnancy fasting plasma glucose and pre-pregnancy body mass index for gestational diabetes mellitus

Yanjuan Zhou, Li Li, Wei Zhang

Abstract

pre-pregnancy body mass index (BMI) for gestational diabetes mellitus (GDM). Healthy singleton pregnant women with natural pregnancy who delivered at the Second People's Hospital of Wuhu City between January 2023 and January 2025 were included. Blood glucose indicators were measured at 11–13 weeks of gestation, and a 75 g oral glucose tolerance test was performed at 24–28 weeks. Participants were classified into GDM and non-GDM groups. After Z-score normalization, univariate and multivariate Logistic regression analyses identified pre-pregnancy BMI, gestational weight gain and FPG as independent risk factors for GDM. The established Logistic regression model showed moderate predictive efficiency, with an AUC of 0.75, an accuracy rate of 0.82, a sensitivity of 0.48, a specificity of 0.92, a PPV of 0.63 and a NPV of 0.86. Bootstrap internal validation and Hosmer–Lemeshow test indicated acceptable model calibration, while decision curve analysis showed clinical net benefit within a threshold probability range of 0.10–0.50. We conclude that early pregnancy FPG combined with pre-pregnancy BMI may help identify women at high risk of GDM and support personalized intervention strategies.

Full Text:

PDF

References

Duncan BB, Magliano DJ and Boyko EJ. IDF Diabetes Atlas 11th edition 2025: global prevalence and projections for 2050. Nephrol Dial Transplant. 2025;41(1):7-9.

He M, Lin Q, Su X, Liu Y, Luo W, Zhang Z, Zeng H, Lin H, Guo X and Yang Y. Residential greenness exposure and repeatedly measured hyperglycemic markers in women with gestational diabetes mellitus: a birth cohort study in Foshan, China. Public Health. 2025;242(1):304-310.

Zhu W, Yang H, Wei Y, Wang Z, Li X, Wu H, Li N, Zhang M, Liu X, Zhang H, Wang Y, Niu J, Gan Y, Zhong L, Wang Y and Kapur A. Comparing the diagnostic criteria for gestational diabetes mellitus of World Health Organization 2013 with 1999 in Chinese population. Chin Med J (Engl). 2015;128(1):125-127.

Wu X, Tiemeier H and Xu T. Trends in gestational diabetes prevalence in China from 1990 to 2024: a systematic review and meta-analysis. Rev Endocr Metab Disord. 2025;26(6):1009-1021.

Syngelaki A, Wright A, Gomez Fernandez C, Mitsigiorgi R and Nicolaides KH. First-trimester prediction of gestational diabetes mellitus based on maternal risk factors. BJOG. 2025;132(7):972-982.

Athanasiadou KI, Paschou SA, Markozannes G, Vasileiou V, Kanouta F, Mitropoulou M, Antsaklis P, Theodora M, Psaltopoulou T, Daskalakis G, Goulis

DG and Anastasiou E. Gestational diabetes mellitus subtypes according to oral glucose tolerance test and pregnancy outcomes. Endocrine. 2025;90(1):95-103.

Yang X, Zhang Y, Xu Y, Xu Y, Zhang M, Guan Q, Hu W, Tun HM and Xia Y. Microbial disturbances caused by pesticide exposure and their predictive implications for gestational diabetes mellitus. Environ Sci Technol. 2025;59(19):9449-9460.

Mohan S, Egan AM. Diagnosis and treatment of hyperglycemia in pregnancy: type 2 diabetes mellitus and gestational diabetes. Endocrinol Metab Clin North Am. 2024;53(3):335-347.

Weinert LS. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Diabetes Care. 2010;33(7):e97-e98.

You H, Hu J, Liu Y, Luo B and Lei A. Risk of type 2 diabetes mellitus after gestational diabetes mellitus: a systematic review & meta-analysis. Indian J Med Res. 2021;154(1):62-77.

Li Q, Zhu Y, Wang J, Zhang Y, Pan Y, Gu R, Guo X and Wei L. Sedentary behaviors and gestational diabetes mellitus: a systematic review. J Obstet Gynaecol Res. 2022;48(2):285-299.

Taylor MK and Sisti G. Fetal hyperechogenic pancreas and gestational diabetes mellitus: a meta-analysis. Minerva Obstet Gynecol. 2024;76(5):452-457.

Smirnakis KV, Martinez A, Blatman KH, Wolf M, Ecker JL and Thadhani R. Early pregnancy insulin resistance and subsequent gestational diabetes mellitus. Diabetes Care. 2005;28(5):1207-1208.

Riskin-Mashiah S, Younes G, Damti A and Auslender R. First-trimester fasting hyperglycemia and adverse pregnancy outcomes. Diabetes Care. 2009;32(9):1639-1643.

Liu B, Chen H, Xu Y, An C, Zhong L, Wang X, Zhang Y, Chen H, Zhang J and Wang Z. Fetal growth is associated with maternal fasting plasma glucose at first prenatal visit. PLoS One. 2014;9(12):e116352.

Wang C, Wei Y, Yang Y, Su R, Song G, Kong L and Yang H. Evaluation of the value of fasting plasma glucose in the first trimester for the prediction of adverse pregnancy outcomes. Diabetes Res Clin Pract. 2021;174(4):108736.

Dincgez B, Ercan I, Sahin I and Erturk NK. The risk of developing gestational diabetes mellitus in maternal subclinical hypothyroidism: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024;309(3):765-774.

Tranidou A, Dagklis T, Tsakiridis I, Siargkas A, Apostolopoulou A, Mamopoulos A, Goulis DG and Chourdakis M. Risk of developing metabolic syndrome after gestational diabetes mellitus - a systematic review and meta-analysis. J Endocrinol Invest. 2021;44(6):1139-1149.

Fabricius EE, Bergholt T, Kelstrup L and Jangö H. Gestational diabetes mellitus affects the risk of obstetric anal sphincter injury: a systematic review and meta-analysis of cohort studies. Int Urogynecol J. 2025;36(1):25-34. doi:10.1007/s00192-024-05989-9

Eleftheriou D, Athanasiadou KI, Sifnaios E, Vagiakis E, Katsaounou P, Psaltopoulou T, Paschou SA and Trakada G. Sleep disorders during pregnancy: an underestimated risk factor for gestational diabetes mellitus. Endocrine. 2024;83(1):41-50.

Hsu MC, Lin CH and Lin MC. Maternal gestational diabetes mellitus and risk of allergic diseases in offspring. Pediatr Neonatol. 2024;65(4):365-369.

Gajera D, Trivedi V, Thaker P, Rathod M and Dharamsi A. Detailed review on gestational diabetes mellitus with emphasis on pathophysiology, epidemiology, related risk factors, and its subsequent conversion to type 2 diabetes mellitus. Horm Metab Res. 2023;55(5):295-303.

Diaz-Santana MV, O'Brien KM, Park YM, Sandler DP and Weinberg CR. Persistence of risk for type 2 diabetes after gestational diabetes mellitus. Diabetes Care. 2022;45(4):864-870.

Şengül M and Selim HŞ. Early Prediction of gestational diabetes mellitus using placental strain elastography and subcutaneous adipose tissue thickness. Z Geburtshilfe Neonatol. 2023;227(4):269-276.

Refbacks

  • There are currently no refbacks.