Distinct pregnancy risks across glycaemic phenotypes of gestational diabetes: a systematic review and meta-analysis — ASN Events
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Distinct pregnancy risks across glycaemic phenotypes of gestational diabetes: a systematic review and meta-analysis (#464)

Tait Mason 1 , Daniella Audish 1 , Xinyi Ji 1 , Devni Nagodavithana 1 , Yitayeh Mengistu 1 , Mahnaz Bahri Khomami 1 , Helena Teede 1 , Aya Mousa 1
  1. Monash Centre for Health Research & Implementation, Monash University, Melbourne, VIC, AU

Gestational diabetes mellitus (GDM) comprises diverse patterns of dysglycaemia, but whether these confer different maternal and neonatal risks remains uncertain. We conducted a systematic review and meta-analysis to determine whether isolated fasting hyperglycaemia (IFH) and isolated postprandial hyperglycaemia (IPH) identify distinct pregnancy risk profiles.

We searched Ovid MEDLINE, EMBASE, EBM-Reviews and grey literature from 2005 to April 2026, for studies classifying GDM according to fasting and postprandial glycaemic abnormalities. Two independent reviewers conducted screening, extraction and appraisal (Newcastle-Ottawa Scale). Random-effects meta-analyses were conducted for maternal and neonatal outcomes.

A total of 49 studies were included (n=622670), of which 17 (n=556391) contributed to this meta-analysis. Compared with IPH, IFH was associated with higher gestational weight gain (MD 1.72 kg; 95%CI 0.88, 2.55), gestational hypertension (OR 1.36; 95%CI 1.22, 1.51), neonatal birthweight (MD 182.3 g; 95%CI 138.9, 225.6), LGA (OR 1.96; 95%CI 1.38, 2.77), and need for medication (insulin: OR 2.61; 95%CI 2.28, 2.99; metformin: OR 2.13; 95%CI 1.59, 2.86), and lower odds of SGA (OR 0.56; 95%CI 0.51, 0.60). Compared with normoglycaemic pregnancies (NGT), IFH was associated with higher odds of gestational hypertension (OR 2.28; 95%CI 1.33, 3.92), LGA (OR 2.10; 95%CI 1.65, 2.68) and neonatal intensive care unit (NICU) admissions (OR 1.74; 95%CI 1.07, 2.83), and lower odds of SGA (OR 0.64; 95%CI 0.56, 0.75), whereas IPH was associated with higher odds of SGA (OR 1.17; 95%CI 1.09, 1.24), preterm birth (OR 1.55; 95%CI 1.10, 2.17) and caesarean section (OR 1.35; 95%CI 1.13, 1.61).

Glycaemic phenotypes are associated with contrasting patterns of pregnancy complications. IFH was characterised predominantly by fetal overgrowth and hypertensive complications, while IPH was associated with earlier delivery and impaired fetal growth. These findings highlight clinically meaningful heterogeneity in GDM and suggest that patterns of dysglycaemia may improve identification of women at risk of adverse pregnancy outcomes.