Atypical glucose response patterns in pregnant women and the association with hypertensive disorders of pregnancy: A retrospective analysis

The oral glucose tolerance test (OGTT) is crucial for diagnosing gestational diabetes mellitus (GDM), yet traditional screening overlooks OGTT curve shapes. Hypertensive disorders of pregnancy (HDP) are common and hyperglycemia is a risk factor, but the relationship between glucose response patterns during OGTT and HDP, remains underexplored. A retrospective cohort study was conducted on 26,084 pregnant women undergoing 75-gram OGTT at 24 to 28 weeks' gestation. Glucose curves were classified as incessant increase (IIn, continuous increase at 0, 1, and 2 hours) or monophasic (MPh, peak at 1 hour followed by decrease). Multivariable logistic regression evaluated crude and adjusted relative risks (RRs) of HDP, adjusting for maternal age, preconception body mass index (BMI), parity, in vitro fertilization (IVF), gestational weight gain (GWG), birth weight, gestational age, and GDM status. Subgroup analyses stratified by age categories, BMI categories, and GDM status were performed. The IIn pattern was observed in 14.46% of participants. Compared with the MPh group, the IIn group demonstrated a significantly lower crude RR of HDP [0.70, 95% confidence interval (CI): 0.59-0.84, P < .001], which persisted after adjustment for confounding variables (adjusted RR = 0.74, 95% CI: 0.61-0.89, P < .01). Stratified analysis demonstrated consistent protective effects of IIn curves across maternal age subgroups, as well as among women with and without GDM. The IIn glucose response curve is independently associated with reduced HDP risk, suggesting its potential as a biomarker for personalized risk assessment.