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Multivariable logistic regression models for pregnancy outcomes were developed. The selection of the covariates to be included in the models was based on findings in previous scientific literature 12 , 13 , and variables of maternal age, BMI and HbA1c level were retained in the model irrespective of statistical significance because all these covariates had a theoretical association with the outcomes. We performed a sensitivity analysis in which we excluded participants without a second OGTT in the early screening group because some of these women may have had GDM but received no related management.

Furthermore, a post hoc analysis was conducted by sub-analysis of maternal age, BMI, HbA1c level, number of parturitions and fetal sex. The cutoff of maternal age was 29 according to our previous finding of an optimized cutoff maternal age for GDM The cutoff of maternal BMI was made at 25 according to the definition of overweight or not. The cutoff of the level of HbAlc was 5. A total of All analyses were performed using SPSS Between January and December , a total of women with intermediate hyperglycemia at the first prenatal visit were identified Figure 1.

The analysis included eligible participants who could be evaluated, of whom underwent early screening and underwent routine screening Figure 1. The occurrence of LGA did not differ between the two groups In terms of newborn characteristics, no significant difference was found in gestational age at delivery, birth weight or male sex proportion between the early OGTT and routine OGTT groups. After propensity score matching, two groups of well-matched cases were generated and balanced regarding baseline characteristics Table 1.

The odds ratios ORs for adverse pregnancy outcomes associated with an early OGTT according to logistic regression models are highlighted in Table 2. Neither sensitivity analysis by exclusion of cases without a second OGTT nor propensity score matching changed this trend Table S1 and Table 2. In terms of secondary outcomes, infants of mothers with early screening had a significantly increased risk of hyperbilirubinemia in both unadjusted unadjusted OR 2.

In both the sensitivity analysis and propensity score matching, statistical significance remained adjusted OR 3.

An early OGTT was related to an increased risk of forceps delivery or shoulder dystocia in the sensitivity analysis adjusted OR 2. A sensitivity analysis taking into account adherence to intervention is shown in Table S1. Our results did not support that an early OGTT among women with intermediate hyperglycemia at the first prenatal visit improved pregnancy outcomes.

There was no evidence of any difference between the groups in the occurrence of primary cesarean birth, preterm birth, shoulder dystocia or forceps delivery, maternal preeclampsia, neonatal hypoglycemia, or low Apgar score.

To the best of our knowledge, this is the first study focusing on the effects of early screening for GDM among women with intermediate hyperglycemia at the first prenatal visit in a real-world setting.

Our results suggested that among women with intermediate hyperglycemia at the first prenatal visit, an early OGTT did not improve pregnancy outcomes, including LGA.

In the present study, an early OGTT during the first-half pregnancy was performed among women with intermediate hyperglycemia at the first prenatal visit and we did not find it to improve pregnancy outcomes. Our findings are consistent with previous studies, which evaluated the value of an early OGTT in other high-risk women or unselected pregnancies 9 , 15 — In contrast, there have been reports of the effects of an early OGTT on a reduced 5 , 18 , 19 or increased risk of LGA 20 — 23 among women with or without other high-risk factors.

Different backgrounds of study populations may explain the differences in the results. This was the first study to evaluate the effects of an early OGTT during the first-half pregnancy versus a routine OGTT after 24 gw among women with intermediate hyperglycemia at the first prenatal visit.

Consequently, there was no benefit of an early OGTT when the time of screening was initiated as early as the first-half pregnancy.

Indeed, our findings that the incidence of neonatal hyperbilirubinemia is increased in women with an early OGTT suggest that such an intervention may be harmful.

This adverse effect may be associated with fetal hyperinsulinemia. However, further study is warranted, as the pathogenesis of neonatal hyperbilirubinemia is complicated. Additionally, in women who later delivered a female baby, an early OGTT increased the risk of LGA, indicating the harm of this intervention among mothers with a female baby. However, the results of post hoc analyses should be considered exploratory, and further evidence is needed to demonstrate this observation.

Overall, the results of our study suggest that women with intermediate hyperglycemia at the first prenatal visit do not benefit from an early OGTT. Intermediate hyperglycemia at the first prenatal visit has been reported to increase the risk of GDM, diagnosed after 24 gw, by approximately ten times, contributing to a higher frequency of LGA and primary cesarean section 7.

Similarly, in the present study, the occurrence of women with LGA in all participants, irrespective of interventions of an early or a routine OGTT, was as high as However, in our present study, interventions of an early OGTT and standard management of glycemia control did not reduce the risk of LGA or other pregnancy outcomes.

The reason for our negative results may be that the GDM diagnostic criteria used at gw may not be appropriate to identify women who truly need interventions, as intermediate hyperglycemia may involve a heterogeneous population.

Hyperglycemia in early pregnancy could be related only to maternal metabolic disturbance due to a specific health status, such concomitant abnormal lipid metabolism 24 or maternal obesity Additionally, it should be noted that all participants received lifestyle education in this real-world study, which may also contribute partly to this negative outcome.

Overall, women with intermediate hyperglycemia are undoubtedly at high risk for GDM and adverse pregnancy. An early OGTT may not be effective in improving pregnancy outcomes among women with intermediate hyperglycemia in real world setting. Further data are needed to identify the truly high-risk pregnancies among these heterogeneous population. There were several strengths of the present study. First, some important variables, such as maternal age and BMI, were distributed uniformly between the early screening and routine screening groups and were included in various regression models to minimize the effects of potential confounding factors.

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