Aim. – To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1–6.9 mmol/L before 22 weeks of gestation (WG), termed ‘early fasting hyperglycaemia’, is associated withfewer adverse outcomes than no initial care.Methods. – A total of 523 women with early fasting hyperglycaemia were retrospectively selected in ourdepartment (2012–2016) and separated into two groups: (i) those who received immediate care(n = 255); and (ii) those who did not (n = 268), but had an oral glucose tolerance test (OGTT) at or after22 WG, with subsequent standard care if hyperglycaemia (by WHO criteria) was present. The number ofcases of large-for-gestational age (LGA) infants, shoulder dystocia and preeclampsia with initial care ofearly fasting hyperglycaemia were compared after propensity score modelling and accounting forcovariates.Results. – Of the 268 women with no initial care, 134 had hyperglycaemia after 22 WG and thenreceived care. Women who received initial care vs those who did not were more likely to be insulin-treated during pregnancy (58.0% vs 20.9%, respectively; P < 0.00001), gained less gestational weight(8.6 5.4 kg vs 10.8 6.1 kg, respectively; P < 0.00001), had a lower rate of preeclampsia [1.2% vs 2.6%,respectively; adjusted odds ratio (aOR): 0.247 (0.082–0.759), P = 0.01], and similar rates of LGA infants (12.2%vs 11.9%, respectively) and shoulder dystocia (1.6% vs 1.5%, respectively). When initial FPG levels were5.5 mmol/L (prespecified group, n = 137), there was a lower rate of LGA infants [6.7% vs 16.1%, respectively;aOR: 0.332 (0.122–0.898); P = 0.03].Conclusion. – Treating women with early fasting hyperglycaemia, especially when FPG is 5.5 mmol/L,may improve pregnancy outcomes, although this now needs to be confirmed by randomized clinicaltrials.