Prediction of gestational diabetes mellitus in the first trimester: comparison of maternal fetuin-A, N-terminal proatrial natriuretic peptide, high-sensitivity C-reactive protein, and fasting glucose levels

Abstract

Objective: We investigated the utility of maternal fetuin-A, N-terminal proatrial natriuretic peptide (pro-ANP), high-sensitivity C-reactive protein (hs-CRP), and fasting glucose levels at 11-14 gestation weeks for predicting pregnancies complicated by gestational diabetes mellitus (GDM). Subjects and methods: This prospective cohort study included 327 low-risk pregnant women who completed antenatal follow-up at a tertiary research hospital between January and April 2014. Maternal blood samples were collected between 11-14 gestational weeks in the first trimester of pregnancy and then stored at-80 °C until further analyses. During follow-up, 29 (8.8%) women developed GDM. The study population was compared 1:2 with age-and body mass index-matched pregnant women who did not develop GDM (n = 59). Fasting plasma glucose (FPG) levels and serum fetuin-A, pro-ANP, and hs-CRP levels were measured using automated immunoassay systems. Results: There was a significant negative correlation between fetuin-A and hs-CRP (CC =-0.21, p = 0.047) and a positive correlation between FPG and hs-CRP (CC = 0.251, p = 0.018). The areas under the receiver operating characteristic curve for diagnosing GDM were 0.337 (p = 0.013), 0.702 (p = 0.002), and 0.738 (p < 0.001) for fetuin-A, hs-CRP, and FPG, respectively. The optimal cutoff values were > 4.65, < 166, and > 88.5 mg/dL for maternal hs-CRP, fetuin-A, and FPG, respectively. Conclusion: Reduced fetuin-A, elevated hs-CRP, and FPG levels in women in the first trimester can be used for the early detection of GDM. Further research is needed before accepting these biomarkers as valid screening tests for GDM. Arch

Effects of dynamic change in fetuin-A levels from the first to the second trimester on insulin resistance and gestational diabetes mellitus: a nested case–control study

“…However, Kralisch et al ,15 Simjak et al ,16 and Farhan et al 11 found that fetuin-A levels did not differ between women with GDM and without at 28th, 29th and 28th–38th gestational weeks, respectively. Another previous study evaluated fetuin-A levels in the first trimester (11–14 gestational weeks), and lower fetuin-A levels were found in 29 women with GDM as compared with 59 healthy pregnant women 14. Limitations of these studies included cross-sectional evaluation at a single time point before the diagnosis of GDM and modest sample sizes.…”

“…Considering GDM shared the similar pathophysiological feature of insulin resistance with T2DM, and women with GDM were at high risk of developing T2DM in later life,10 it could be speculated that fetuin-A might also be an important biomarker involved in the pathogenesis of GDM development. However, so far, limited research on the correlation between fetuin-A and GDM yielded inconsistent findings 11–16. Some of them found significant differences in fetuin-A concentration between healthy pregnant and GDM group,12–14 while others did not 11 15 16.…”

“…However, so far, limited research on the correlation between fetuin-A and GDM yielded inconsistent findings 11–16. Some of them found significant differences in fetuin-A concentration between healthy pregnant and GDM group,12–14 while others did not 11 15 16. Previous studies were mainly limited by relatively small sample size and most of them measured fetuin-A concentration at or after the time of diagnosis of GDM.…”

“…Previous studies were mainly limited by relatively small sample size and most of them measured fetuin-A concentration at or after the time of diagnosis of GDM. Only one paper focused on fetuin-A levels at a single time point before the diagnosis of GDM 14. None of the previous studies analyzed the dynamic change of fetuin-A concentration before the diagnosis of GDM.…”

Fetuin-A and fetal growth in gestational diabetes mellitus

“…Fetuin-A inhibits insulin receptor signaling4 5 and is an endogenous ligand of toll-like receptor 4 promoting lipid-induced insulin resistance 6. Gestation diabetes mellitus (GDM), a condition characterized by elevated insulin resistance and impaired glucose tolerance in the second half of the pregnancy,7 has been associated with elevated maternal circulating fetuin-A levels in some but not all studies 8–10. There is a lack of data on whether there are alterations in fetal/cord blood fetuin-A concentrations in GDM.…”