Clinical and Biochemical Markers in Early Pregnancy for Prediction of Gestational Diabetes Mellitus.

Abstract

Introduction: Gestational Diabetes Mellitus (GDM) is associated with an increased risk of feto-maternal and neonatal complications. Many of these complications can be reduced or eliminated, if GDM can be predicted in early pregnancy. Current risk prediction models lack a strong predictive value. In this study, we aim to evaluate the early trimester maternal parameters for future prediction of GDM.

Methods: In this prospective observational study, we screened 581 consecutive healthy women with singleton pregnancy for GDM during their first antenatal visit. After informed consent, fasting blood samples were collected and stored at -80°C. GDM was diagnosed as per IADPSG criteria. During prospective follow-up, a total of 55 patients developed GDM. A total of 110 age and BMI-matched controls were recruited for comparison. In all women, we measured the Oral Glucose Tolerance test with 75 gm anhydrous glucose, fasting insulin, HbA1c, hsCRP, uric acid, and lipid Profile. HOMA-IR, HOMA-β, and QUICKI were also assessed.

Results: The GDM cohort had significantly higher median waist circumference, 2 hr plasma glucose, HbA1c, fasting insulin, HOMA-IR, hsCRP, uric acid, and serum triglyceride levels. Multiple regression analysis revealed HbA1c (OR 5.264; P = 0.007), 2 hr PPG (OR 1.026; P = 0.035), QUICKI (OR 1.057; P = 0.016), uric acid (OR 1.931; P = 0.013) and neutrophil: lymphocyte ratio (OR 1.545; P = 0.008) to be independently associated with GDM outcome with combined area under the curve (AUC) of 0.850, a sensitivity of 72.7%, and a specificity of 87.3%.

Conclusion: Fasting Insulin, HbA1c, HOMA-IR, hsCRP, and Uric acid levels are significantly increased in early pregnancy in individuals who subsequently develop GDM.