First-Trimester Prediction of Gestational Diabetes Mellitus: Examining the Potential of Combining Maternal Characteristics and Laboratory Measures

Abstract

OBJECTIVEPredictors of gestational diabetes mellitus (GDM) have been widely studied, but few studies have considered multiple measures. Our objective was to integrate several potential GDM predictors with consideration to both simple and novel measures and to determine the extent to which GDM can be predicted in the first trimester.RESEARCH DESIGN AND METHODSWe identified first-trimester maternal samples from 124 women who developed GDM and 248 control subjects who did not. We gathered data on age, BMI, parity, race, smoking, prior GDM, family history of diabetes, and blood pressure. Using retrieved samples, we measured routine (lipids, high-sensitivity C-reactive protein, and γ-glutamyltransferase) and novel (adiponectin, E-selectin, and tissue plasminogen activator [t-PA]) parameters. We determined independent predictors from stepwise regression analyses, calculated areas under the receiver-operating characteristic curves (AUC-ROC), and integrated discrimination improvement (IDI) for relevant models.RESULTSCompared with control subjects, women who subsequently developed GDM were older, had higher BMIs, were more likely to be of Asian origin, had a history of GDM or family history of type 2 diabetes, and had higher systolic blood pressure (P < 0.05 for all). With regard biochemical measures, stepwise analyses identified only elevated t-PA and low HDL cholesterol levels as significant (P ≤ 0.015) independent predictors of GDM beyond simple non–laboratory-based maternal measures. Their inclusion improved the AUC-ROC from 0.824 to 0.861 and IDI by 0.052 (0.017–0.115).CONCLUSIONSGDM can be usefully estimated from a mix of simple questions with potential for further improvement by specific blood measures (lipids and t-PA).

Single-Step First Trimester Screening “Sooner the Better”

“…Many other studies [3,7,[12][13][14] supported similar finding. In fact, one of the studies gave strong recommendation that algorithms derived from multiple regression analysis of maternal characteristics and obstetric history can potentially identify about 60 % pregnancy that will develop GDM [13].…”

A two-step screening algorithm including fasting plasma glucose measurement and a risk estimation model is an accurate strategy for detecting gestational diabetes mellitus

“…Savvidou et al have demonstrated that several biochemical measurements in the first trimester of pregnancy can improve the discrimination of high-and low-risk individuals, in addition to simple anamnestic variables using the WHO criteria for diagnosing GDM [34]. However, inclusion of some novel risk variables did not improve test accuracy in our analysis; therefore, and to optimise the cost-effectiveness of the algorithm, these biochemical variables were not included in our prediction model, which was primarily based on cheap and simple variables that are ubiquitously available in an obstetric setting.…”

Normalizing Metabolism in Diabetic Pregnancy: Is It Time to Target Lipids?

“…Disentangling the effect of maternal obesity per se from that of maternal diabetes on maternal metabolism and pregnancy outcomes in the women with obesity and diabetes in pregnancy is almost impossible without very large cohorts with refined metabolic measures. In observational studies and larger population cohort studies in normal pregnancy, increasing maternal triglycerides in early pregnancy have been associated with increased rates of preeclampsia (4,5), future diagnosis of GDM (17,23), induced preterm delivery (5), and LGA infants (5). Low maternal HDL-C in early pregnancy has also been associated with increased risk of later GDM (23), and elevated HDL-C has been associated with lower rates of preterm birth (24).…”

“…In observational studies and larger population cohort studies in normal pregnancy, increasing maternal triglycerides in early pregnancy have been associated with increased rates of preeclampsia (4,5), future diagnosis of GDM (17,23), induced preterm delivery (5), and LGA infants (5). Low maternal HDL-C in early pregnancy has also been associated with increased risk of later GDM (23), and elevated HDL-C has been associated with lower rates of preterm birth (24). Both low (,10th centile) and high (.90th centile) maternal total cholesterol have been associated with preterm birth (6,25), with one study showing a trend to increased rates of microcephaly for low (,10th centile) maternal cholesterol (25) ( Table 2).…”