Abstract 116: Clinical and biochemical predictors in early pregnancy for development of gestational diabetes mellitus

Abstract

Background: Early prediction of GDM is vital. Current risk prediction models are based on maternal and clinical parameters, lacking a strong predictive value.Objective: To identify clinical and biochemical parameters in early pregnancy for prediction of GDM.Methods: In this prospective cohort study, we screened 581 consecutive healthy women with singleton pregnancy for GDM during their first antenatal visit. Fasting blood samples were collected and stored at -800C. Detailed history and clinical assessment were done for each patient and findings were noted in a pre-specified proforma. GDM was diagnosed as per IADPSG criteria at 24-28 weeks. During prospective follow up, 55 patients developed GDM. A total of 110 age and BMI matched controls were recruited for comparison. We measured OGTT, fasting insulin, HbA1c, hsCRP, uric acid and Lipid Profile. HOMA-IR, HOMA-β and QUICKI were used to estimate insulin sensitivity and β-cell function.Results: Significant higher proportion of subjects in GDM cohort had presence of Acanthosis nigricans, positive family history of T2DM in 1st degree relative. GDM cohort had significantly higher waist circumference, 2 hr plasma glucose, HbA1c, fasting insulin, HOMA-IR, uric acid and serum triglyceride levels. The area under the curve were as follows: HbA1c - 0.71 (95%CI: 0.628–0.793), Fasting Insulin - 0.748 (95%CI: 0.671–0.826), hsCRP - 0.634 (95%CI: 0.546 - 0.722) and Uric acid - 0.693 (95%CI: 0.606–0.780). Multiple regression analysis revealed HbA1c (OR 4.225; 95%CI – 1.421-12.561), 2 hr PPG (OR 1.026; 95%CI – 1.003-1.049), Insulin (OR 1.057; 95%CI – 1.006-1.111) and uric acid (OR 1.039; 95%CI – 1.026-2.793) to be independently associated with GDM outcome.Conclusions: Fasting Insulin, HbA1c, HOMA-IR, hsCRP and Uric acid levels are significantly altered in early pregnancy in individuals who develop GDM subsequently. Hence utilization of these parameters may identify at risk group in routine clinical care and help in improving feto-maternal outcome.