Punnose J, Sukhija K, Rijhwani RM. Intermediate hyperglycemia in early pregnancy: A South Asian perspective. World J Diabetes 2023; 14(5): 573-584 [PMID: 37273252 DOI: 10.4239/wjd.v14.i5.573]
Corresponding Author of This Article
John Punnose, MD, Dean, Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Tis Hazari, Delhi 110054, India. drpunnose@rediffmail.com
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. May 15, 2023; 14(5): 573-584 Published online May 15, 2023. doi: 10.4239/wjd.v14.i5.573
Intermediate hyperglycemia in early pregnancy: A South Asian perspective
John Punnose, Komal Sukhija, Rashika M Rijhwani
John Punnose, Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
Komal Sukhija, Rashika M Rijhwani, Department of Endocrinology, St.Stephen’s Hospital, Delhi 110054, India
Author contributions: Punnose J, Sukhija K, and Rijhwani RM contributed equally to this work; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The Authors have no conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Punnose, MD, Dean, Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Tis Hazari, Delhi 110054, India. drpunnose@rediffmail.com
Received: December 19, 2022 Peer-review started: December 19, 2022 First decision: January 17, 2023 Revised: January 28, 2023 Accepted: April 7, 2023 Article in press: April 7, 2023 Published online: May 15, 2023 Processing time: 147 Days and 4.7 Hours
Abstract
“Intermediate hyperglycemia in early pregnancy (IHEP)” refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for “overt diabetes” in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.
Core Tip: Intermediate hyperglycemia in early pregnancy (IHEP) is a common metabolic disorder among South Asian pregnant women, and it accounts for one-third of women with “gestational diabetes mellitus”. The benefits of early therapeutic intervention for these women have not been established. The guidelines on the screening and management of IHEP by international and regional professional bodies are conflicting, producing major confusion in obstetric practice in South Asian countries. There is an urgent need for randomized controlled trials to settle the ongoing controversies in this field.
