Gestational blood glucose management: A potential strategy to reduce pre-eclampsia risk

Pre-eclampsia is one of the main causes of death in pregnant women. Researchers from China conducted a large multicenter retrospective study involving 53,054 singleton pregnancies in China and identified that elevated blood glucose levels in the first trimester and significant gestational blood glucose fluctuations increase the risk of pre-eclampsia in a U-shaped pattern. These findings provide new evidence for optimizing gestational glucose monitoring strategies, highlighting the need for enhanced blood glucose management.  

Pre-eclampsia is a leading cause of maternal death worldwide. While earlier research has pointed to a possible link between blood glucose levels and preeclampsia, the specific dose-response connection between blood glucose fluctuations during pregnancy and preeclampsia risk has long remained unclear.

A research team led by Professor Xiaoli Wang from School of Public Health, Peking University, in collaboration with Professor Yuan Wei’s team from Peking University Third Hospital, published a study titled "Dose-response relationship between gestational blood glucose levels and risk of pre-eclampsia in singleton pregnancies: A retrospective multicenter study" in the Chinese Medical Journal on April 23, 2026. This large-scale retrospective cohort study revealed the complex relationship between gestational blood glucose levels and the risk of preeclampsia.

This study, based on data from 53,054 singleton pregnancies across 121 hospitals in China (2015–2018), uncovered a dose-response relationship between first-trimester blood glucose levels and pre-eclampsia risk. The study strictly enrolled participants without pre-pregnancy chronic hypertension, diabetes, or impaired glucose tolerance, collecting their first-trimester fasting plasma glucose levels and blood glucose data at pre-eclampsia assessment, with pre-eclampsia diagnosed by Chinese Society of Obstetrics and Gynecology criteria. Using logistic regression models with restricted cubic splines and robust Poisson regression, the research team analyzed the dose–response relationship between first-trimester blood glucose, gestational blood glucose changes and pre-eclampsia risk, adjusting for covariates including region, age, education, pre-pregnancy body mass index, and assisted reproductive technology use to ensure result validity.

The study’s key findings are straightforward: the risk of pre-eclampsia rises notably as blood glucose levels in the first trimester go up. Even a mild increase in blood glucose during early pregnancy is tied to a higher chance of developing pre-eclampsia, with the risk growing steadily as glucose levels increase. Most importantly, the study found a distinct U-shaped relationship between gestational blood glucose fluctuations and pre-eclampsia risk. In other words, both extreme climb and sharp drop in blood glucose during pregnancy can raise pre-eclampsia risk, while keeping blood glucose levels relatively stable throughout pregnancy is linked to the lowest likelihood of developing the condition. This core conclusion held true across different groups of pregnant women, further emphasizing the significance of stable blood glucose levels during pregnancy.

These results build on prior research in this field, which had hinted at a potential link between high blood glucose and pre-eclampsia but lacked concrete evidence on how blood glucose fluctuations during pregnancy impact the condition. Notably, the study confirmed that the connection between blood glucose and pre-eclampsia remains significant even after accounting for obesity—a well-known major risk factor for pre-eclampsia. This highlights that blood glucose control plays an independent and key role in preventing this serious pregnancy complication.

The study makes clear that blood glucose management is crucial not only for pregnant women with gestational diabetes, but for all expectant mothers looking to lower their pre-eclampsia risk. By quantifying the effects of both early pregnancy glucose levels and gestational blood glucose changes, the research delivers clear, practical insights for clinical practice that go beyond what existing studies have uncovered. These findings provide new empirical evidence for optimizing gestational glucose monitoring protocols and emphasize the need to strengthen blood glucose management in clinical care. The research team recommends enhancing blood glucose screenings for pregnant women, and in particular, implementing early pregnancy interventions to reduce the chance of adverse pregnancy outcomes.

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About Shang Ma from Peking University

Postgraduate

Department of Maternal and Child Health, School of Public Health, Peking University.

Research Focus: Perinatal care

About Yuan Wei from Peking University Third Hospital

Professor and Chief Physician, Doctoral Supervisor, Director of the Department of Obstetrics, Peking University Third Hospital

Research Focus: Twin pregnancies, perinatal care, prenatal diagnosis, fetal medicine.

About Xiaoli Wang from Peking University

Professor of School of Public Health, Peking University, Doctoral Supervisor Maternal, Child and Adolescent Health

Research Focus: Early childhood development, perinatal maternal psychological and behavioral health

Funding information

This work was supported by grants from the National Key Research and Development Program of China (Nos. 2023YFC2705900 and 2022YFC2705305).