Objectives Early diagnosis of gestational diabetes can lead to greater optimization of glucose control. We evaluated associations between maternal serum analytes (alpha-fetoprotein [AFP], free beta-human chorionic gonadotropin [beta-hCG], inhibin, and estriol) and the development of gestational diabetes mellitus (GDM). Methods This retrospective cohort study identified single-ton pregnancies with available second trimester serum analytes between 2009 and 2017. GDM was identified by ICD-9 and -10 codes. We examined the associations between analyte levels and GDM and to adjust for potential confounders routinely collected during genetic serum screening (maternal age, BMI, and race) using logistic regression. Optimal logistic regression predictive modeling for GDM was then performed using the analyte levels and the above mentioned potential confounders. The performance of the model was assessed by receiver operator curves. Results Out of 5,709 patients, 660 (11.6%) were diagnosed with GDM. Increasing AFP and estriol were associated with decreasing risk of GDM, aOR 0.76 [95% CI 0.60–0.95] and aOR 0.67 [95% CI 0.50–0.89] respectively. Increasing beta-hCG was associated with a decreasing risk for GDM(aOR 0.84 [95% CI 0.73–0.97]). There was no association with inhibin. The most predictive GDM predictive model included beta-hCG and estriol in addition to the clinical variables of age, BMI, and race (area under the curve (AUC 0.75), buy this was not statistically different than using clinical variables alone (AUC 0.74) (p=0.26). Conclusions Increasing second trimester AFP, beta-hCG, and estriol are associated with decreasing risks of GDM, though do not improve the predictive ability for GDM when added to clinical risk factors of age, BMI, and race.

中文翻译：

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妊娠期糖尿病的孕中期预测：母体分析物作为额外的筛查工具

目的 妊娠期糖尿病的早期诊断可以更好地优化血糖控制。我们评估了母体血清分析物（甲胎蛋白 [AFP]、游离 β-人绒毛膜促性腺激素 [β-hCG]、抑制素和雌三醇）与妊娠期糖尿病 (GDM) 发展之间的关联。方法 这项回顾性队列研究确定了 2009 年至 2017 年期间具有可用的孕中期血清分析物的单胎妊娠。GDM 由 ICD-9 和 -10 代码确定。我们检查了分析物水平与 GDM 之间的关联，并使用逻辑回归调整了在遗传血清筛查（母亲年龄、BMI 和种族）期间常规收集的潜在混杂因素。然后使用分析物水平和上述潜在混杂因素对 GDM 进行最佳逻辑回归预测模型。模型的性能通过接收者操作曲线进行评估。结果 在 5,709 名患者中，660 名 (11.6%) 被诊断为 GDM。增加 AFP 和雌三醇与降低 GDM 风险相关，aOR 0.76 [95% CI 0.60–0.95] 和 aOR 0.67 [95% CI 0.50–0.89]。增加 β-hCG 与降低 GDM 风险相关（aOR 0.84 [95% CI 0.73–0.97]）。与抑制素无关。最具预测性的 GDM 预测模型包括 β-hCG 和雌三醇，以及年龄、BMI 和种族等临床变量（曲线下面积 (AUC 0.75)，与单独使用临床变量 (AUC 0.74) 相比没有统计学差异） (p = 0.26)。