Abstract
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.
Funding source: National Center on Minority Health and Health Disparities, NIH
Award Identifier / Grant number: U54MD007601
Award Identifier / Grant number: U54MD007584
Funding source: University of Hawaii John A Burns School of Medicine Department of Obstetrics, Gynecology, and Women's Health
Acknowledgments
Statistical analysis was funded by the University of Hawaii John A Burns School of Medicine Department of Obstetrics, Gynecology, and Women's Health and NIH infrastructural grants U54MD007584 and U54MD007601.
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Research funding: Statistical analysis was funded by the University of Hawaii John A Burns School of Medicine Department of Obstetrics, Gynecology, and Women's Health and NIH infrastructural grants U54MD007584 and U54MD007601.
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Author contributions: 1. Meryl Sperling – study design, data collection, manuscript writing. 2. Dena Towner – study design, manuscript editing. 3. James Davis – study design, statistical analysis. 4. Kelly Yamasato – study design, data collection, manuscript editing. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Not applicable.
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Ethical approval: All protocols performed in this study were in accordance with the ethical standards of the University of Hawaii and in accordance with the 1964 Helsinki declaration and its later amendments. For this retrospective study, formal consent was not required as per the Institutional Review Board.
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