From early hyperglycemia to gestational diabetes: Improving diagnosis and prediction

Early pregnancy hyperglycemia is an important area of obstetric practice because glucose abnormalities detected in the first trimester may represent previously unrecognised diabetes, early gestational diabetes mellitus (eGDM), or an increased risk of hyperglycemia emerging later in pregnancy. However, the distinction between diagnosing eGDM at booking and predicting conventional GDM after 24 weeks remains clinically and conceptually challenging. Although early identification may enable timely intervention, uncertainty persists regarding diagnostic thresholds, the interpretation of fasting and post-load glucose measurements, and the extent to which early treatment improves maternal and neonatal outcomes. Recent studies have associated early pregnancy hyperglycemia with obesity, insulin resistance, hypertensive disorders, fetal overgrowth and adverse perinatal outcomes, but findings vary according to population, screening strategy and definition of eGDM. Current approaches include universal and risk-based testing, use of clinical risk factors and biomarkers, and prediction models combining biochemical, demographic and metabolic measures. Nevertheless, many models lack external validation, and evidence is insufficient to determine whether early treatment should follow the same pathway as conventional GDM management or be tailored to distinct phenotypes.This Research Topic aims to clarify the clinical, biological and methodological distinctions between early pregnancy hyperglycemia diagnosis and GDM prediction. It will examine which diagnostic criteria and risk-stratification strategies most accurately identify clinically meaningful disease, how early hyperglycemia relates to later GDM and pregnancy outcomes, and whether early lifestyle or pharmacological interventions improve maternal and neonatal health. Contributions may also assess the effectiveness, equity and feasibility of different screening pathways across diverse healthcare settings.To gather further insights in the diagnosis, prediction and management of hyperglycemia during early pregnancy, we welcome articles addressing, but not limited to, the following themes:- Definitions and diagnostic criteria for eGDM and overt diabetes in pregnancy- Distinguishing early GDM diagnosis from prediction of GDM at 24–28 weeks- Fasting glucose, HbA1c, oral glucose tolerance testing and continuous glucose monitoring- Clinical, metabolic, genetic and novel biomarker-based prediction models- The relationship between early pregnancy hyperglycemia and later GDM- Maternal, fetal and neonatal outcomes associated with eGDM- Early lifestyle, nutritional and pharmacological interventions- Risk-based versus universal screening strategies- Validation, calibration and clinical utility of prediction tools- Health inequalities, patient perspectives and implementation in obstetric practice Topic editors: A.Seval Ozgu-Erdinc, Ioana Rotar Source: https://www.frontiersin.org/research-topics/85931/from-early-hyperglycemia-to-gestational-diabetes-improving-diagnosis-and-prediction