LBODP049 Clinical And Biochemical Markers In Early Pregnancy For Prediction Of Gestational Diabetes Mellitus

Abstract

Abstract Background Early identification of Gestational Diabetes Mellitus (GDM) is pivotal to reduce feto-maternal complications associated with the disease. Current risk prediction models that are based on maternal clinical and biochemical parameters lack a strong predictive value. Objective To evaluate the early trimester maternal parameters for prediction of gestational diabetes mellitus. 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 -800C. GDM was diagnosed as per IADPSG criteria. During prospective follow up, total 55 patients developed GDM. A total of 110 age and BMI matched controls were recruited for comparison. In all women, we measured Oral Glucose Tolerance test (OGTT) with 75 gm anhydrous glucose, fasting insulin, HbA1c, hsCRP, uric acid and Lipid Profile. HOMA-IR, HOMA-β and QUICKI were used to evaluate insulin sensitivity and β-cell function. Results Significant higher proportion of subjects in GDM cohort had presence of acanthosis nigricans and positive family history of Type 2 Diabetes Mellitus in first degree relative. The GDM cohort had significantly higher median waist circumference, 2hr plasma glucose (2hr PPG), HbA1c, fasting insulin, HOMA-IR, uric acid and serum triglyceride levels. The receiver operating characteristic (ROC) curve were as follows: HbA1c - 0.74 (95%CI: 0.661–0.819), Fasting Insulin - 0.748 (95%CI: 0.671–0.826), high sensitivity C-Reactive Protein (hsCRP) - 0.689 (95%CI: 0.605 - 0.773) and Uric acid - 0.718 (95%CI: 0.635–0.802). Multiple regression analysis revealed HbA1c (OR 5.264; p=0. 007), 2hr PPG (OR 1. 026; p=0. 035), QUIKI (OR 1. 057; p=0. 016), uric acid (OR 1. 039; p=0. 013) and neutrophil: lymphocyte ratio (OR 1.545; p=1. 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%. Conclusions Fasting Insulin, HbA1c, HOMA-IR, hsCRP and Uric acid levels are significantly increased in early pregnancy in individuals who develop GDM subsequently, compared to women who did not develop GDM. Hence utilization of these parameters may identify at risk group in routine clinical care and help in improving feto-maternal outcome. Presentation: No date and time listed