International Journal of Clinical Obstetrics and Gynaecology

Background: Gestational diabetes mellitus (GDM) is conventionally screened at first antenatal visit followed by 24-28 weeks, limiting intervention opportunities during critical fetal developmental periods. Early pregnancy metabolic dysfunction may predict subsequent GDM development.

Objective: To evaluate the association between 2-hour postprandial blood sugar (2HR PPBS)>110 mg/dL at 8-10 weeks gestation and subsequent GDM development.

Methods: This prospective cohort study conducted at JSS Hospital, Mysuru, Karnataka, enrolled 138 pregnant women at 8-10 weeks gestation using consecutive sampling. Women who had 2HRPPBS >11Omg/dl were followed throughout pregnancy to see if they developed GDM. Diagnostic performance, risk factors, and multivariate predictors were analyzed using chi-square tests, independent t-tests, logistic regression, and ROC analysis.

Results: Among 138 participants (mean age 28.7±5.7 years, mean BMI 23.8±3.2 kg/m²), 23.9% (33/138) developed GDM. 33 women with 2HR PPBS >110 mg/dL (n=41, 29.7%) developed GDM, while none with values ?110 mg/dL developed GDM. The screening test demonstrated perfect sensitivity (100%, 95% CI: 89.4-100%), excellent specificity (92.4%, 95% CI: 85.5-96.7%), positive predictive value of 80.5% (95% CI: 65.1-91.2%), and perfect negative predictive value (100%, 95% CI: 96.3-100%). Area under ROC curve was 0.985 (95% CI: 0.965-1.000, p<0.001). Multivariate analysis revealed 2HR PPBS >110 mg/dL as the dominant predictor with odds ratio of 133.2 (95% CI: 31.0-571.8, p<0.001), explaining 78.9% of variance independently. Additional significant risk factors included elevated BMI (OR 1.21 per unit, p=0.042), family history of diabetes (37.5% vs 16.7%, p=0.003), and sedentary lifestyle (32.1% vs 0% in active women, p=0.049).

Conclusion: 2HR PPBS >110 mg/dL at 8-10 weeks gestation represents an exceptional early predictor of GDM with perfect sensitivity and excellent specificity, enabling timely intervention during critical developmental periods. This simple, cost-effective screening approach warrants validation in larger, multi-center populations.