Prediabetes before pregnancy: implications for risk stratification and research.

PURPOSE OF REVIEW: This review evaluates whether pregestational prediabetes identifies women at risk of subsequent gestational diabetes mellitus (GDM) and examines its association with maternal and offspring outcomes. RECENT FINDINGS: Prediabetes is common in women of reproductive age and often precedes GDM. The risk factors for prediabetes and GDM are similar, such as higher BMI, polycystic ovary syndrome, advancing age, and genetic susceptibility. Both conditions denote underlying insulin resistance with limited beta-cell reserve. Preliminary evidence indicates that women with pregestational prediabetes have a higher likelihood of developing GDM. Risk rises progressively with increasing glycemia. Prediabetes is also associated with modestly increased risks of hypertensive disorders of pregnancy and preterm birth, though associations with cesarean delivery, macrosomia, and neonatal outcomes are inconsistent. Glycated hemoglobin in the prediabetes range early in pregnancy is associated with a higher risk of progression to type 2 diabetes than GDM diagnosed at 24-28 weeks. These observations support the view that pregestational prediabetes may emerge as an early marker of metabolic risk with implications extending beyond pregnancy. SUMMARY: Prediabetes represents a state of increased metabolic risk in women planning pregnancy. It lies along a dysglycemic continuum linking preconception glycemic status to GDM and future diabetes. Incorporating glycemic assessment into preconception care may aid GDM risk stratification. However, the evidence is still evolving, and prospective studies are needed to define the role of pregestational prediabetes in predicting maternal, fetal, and long-term outcomes.