目的:妊娠糖尿病的早期诊断可以导致血糖控制的更优化。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)和妊娠期糖尿病(GDM)的发展。
方法:这项回顾性队列研究在2009年至2017年之间确定了单吨位妊娠,并使用了孕中期血清分析物。GDM由ICD-9和-10编码鉴定。我们检查了分析物水平与GDM之间的关联,并调整了在遗传血清筛查期间常规收集的潜在混杂因素(母亲年龄,BMI,和种族)使用逻辑回归。然后使用分析物水平和上述潜在混杂因素进行GDM的最佳逻辑回归预测建模。通过接收器操作员曲线评估模型的性能。
结果:在5,709名患者中,660例(11.6%)被诊断为GDM。AFP和雌三醇的增加与GDM的风险降低有关,AOR0.76[95%CI0.60-0.95]和AOR0.67[95%CI0.50-0.89]分别。增加β-hCG与GDM风险降低相关(aOR0.84[95%CI0.73-0.97])。与抑制素没有关联。最具预测性的GDM预测模型除了年龄的临床变量外,还包括β-hCG和雌三醇,BMI,和种族(曲线下面积(AUC0.75),这与单独使用临床变量(AUC0.74)没有统计学差异(p=0.26).
结论:妊娠中期AFP增加,β-hCG,和雌三醇与降低GDM的风险有关,虽然没有提高GDM的预测能力,当添加到年龄的临床危险因素,BMI,和种族。
OBJECTIVE: 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.