Abstract
ObjectiveGestational diabetes mellitus (GDM) is a serious threat to maternal and child health. However, there isn’t a standard predictive model for the disorder in early pregnancy. This study is to investigate the association of blood indexes with GDM and establishes a practical predictive model in early pregnancy for GDM.MethodsThis is a prospective cohort study enrolling 413 pregnant women in the department of Obstetrics and Gynecology in Shanghai General Hospital from July 2020 to April 2021.A total of 116pregnantwomen were diagnosed with GDM during the follow-up. Blood samples were collected at early trimester (gestational weeks 12-16) and second trimester(gestational weeks 24-26 weeks). A predictive nomogram was established based on results of the multivariate logistic model and 5-fold cross validation. We evaluate the nomogram by the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCAs).ResultsSignificant differences were observed between the GDM and normal controls among age, pre-pregnancy BMI, whether the pregnant women with complications, the percentage of B lymphocytes, fasting plasma glucose (FPG), HbA1c, triglyceride and the level of progesterone in early trimester. Risk factors used in nomogram included age, pre-pregnancy BMI, FPG, HbA1c, the level of IgA, the level of triglyceride, the percentage of B lymphocytes, the level of progesterone and TPOAb in early pregnancy. The AUC value was 0.772, 95%CI (0.602,0.942). The calibration curves for the probability of GDM demonstrated acceptable agreement between the predicted outcomes by the nomogram and the observed values. DCA curves showed good positive net benefits in the predictive model.ConclusionsA novel predictive nomogram was developed for GDM in our study, which could do help to patient counseling and management during early pregnancy in clinical practice.
Highlights
Gestational diabetes mellitus (GDM) is the most common metabolic syndrome defined as diabetes diagnosed in the second and third trimester of pregnancy, which characterized as hyperglycemia [1]
Significant differences were observed between the GDM and normal controls among age, pre-pregnancy BMI, whether the pregnant women with complications, the percentage of B lymphocytes, fasting plasma glucose (FPG), HbA1c, triglyceride and the level of progesterone in early trimester
Risk factors used in nomogram included age, pre-pregnancy BMI, FPG, HbA1c, the level of IgA, the level of triglyceride, the percentage of B lymphocytes, the level of progesterone and Thyroid peroxidase antibody (TPOAb) in early pregnancy
Summary
Gestational diabetes mellitus (GDM) is the most common metabolic syndrome defined as diabetes diagnosed in the second and third trimester of pregnancy, which characterized as hyperglycemia [1]. GDM brings great risks to both the mother and developing fetus [4]. For the mother, it increases the risk of cesarean section, preeclampsia and the type 2 diabetes after delivery. It increases the risk of cesarean section, preeclampsia and the type 2 diabetes after delivery For the fetus, it makes them face the risk of adverse pregnancy outcomes, such as malformation, preterm labor, and macrosomia even dystocia etc. The increase hyperglycemia is associated with the rising incidence of obesity and metabolic syndrome in adolescence [7]
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