Clinical implications
While GDM is considered an unequivocal risk factor for T2DM, the impact of 1st trimester FPG levels on future T2DM development is unknown. Moreover, the early pregnancy FPG level that determines the need for postpartum follow-up is not well defined. Our results set a cut-off for FPG levels from which the risk for T2DM increases, at least comparably to the prediction by GDM. Moreover, the cut-off level of 86.5 mg/dl performs better for T2DM prediction for all women, but especially for those without obesity. Women with GDM or obesity are already considered at risk for T2DM and are advised for lifestyle modification and T2DM screening at least once every three years 3. Our results point out that special attention should be paid to women without obesity with 1st-trimester FPG levels above 86 mg/dl, regardless of their GDM status, as they are also at increased risk of future T2DM.
Our study underscores the significance of 1st trimester FPG levels on the risk for future T2DM. Nevertheless, screening by FPG during early pregnancy is still not widely advised for all women, mostly due to a lack of randomized controlled studies that demonstrate the perinatal benefits of intervention during early pregnancy. To advance this field, it is essential to conduct randomized controlled trials that evaluate the benefits of immediate intervention according to 1st-trimester FPG levels in the postpartum population in different settings. Additionally, long-term evaluation of risk for T2DM and benefits in intervention for women with high 1st trimester FPG levels, as well as cost-analysis studies, have the potential to reshape the current paradigmof GDM diagnosis during pregnancy, implications, and interventions for long-term health.