Early Predictors of Gestational Diabetes Mellitus and Preeclampsia: Rationale for A Personalized Screening Strategy in The First Trimester

To identify early clinical and metabolic predictors of gestational diabetes mellitus (GDM) and preeclampsia in the first trimester of pregnancy and to justify the need for a personalized screening strategy. Materials and Methods: A retrospective case-control cohort study was conducted at the Multidisciplinary City Hospital No. 2 in Astana (n=600). The main group consisted of 300 pregnant women with GDM, and the control group comprised 300 women with physiological pregnancy. Anthropometric data (BMI), medical history, and laboratory indicators (fasting glucose, HbA1c) recorded at registration (up to 12 weeks) were analyzed. Statistical analysis included the Mann-Whitney U-test, odds ratio (OR) calculation, and ROC analysis. Results: Patients with GDM had significantly higher BMI (obesity in 31.0 % vs. 9.0 %, p<0.001) and age. The incidence of preeclampsia in the GDM group was 7.3 % vs. 3.3 % in the control group; it was established that GDM increases the risk of preeclampsia by more than two times(OR=2.295; 95 % CI: 1.067–4.934). ROC analysis revealed high diagnostic value of individual markers in the first trimester. Fasting glucose at a threshold of >4.49 mmol/L showed a sensitivity of 71.6 % and specificity of 76.6 % (AUC=0.787; 95 % CI: 0.745–0.825). Glycated hemoglobin (HbA1c) at a level >5.27 % demonstrated a sensitivity of 63.9 % and high specificity of 85.7 % (AUC=0.792; 95 % CI: 0.653–0.894). The developed combined prognostic model (HbA1c + fasting glucose) showed the highest predictive value with an area under the ROC curve (AUC) of 0.849, providing a sensitivity of 90.0 % and specificity of 78.2 %. Conclusion: Glycated hemoglobin and fasting glycemia in the first trimester are independent predictors of GDM and associated preeclampsia. Implementing a risk score assessment at the first antenatal visit allows for the identification of a group for early initiation of personalized prevention, without waiting for the standard OGTT timing (24–28 weeks), which may reduce the incidence of obstetric complications. 

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