scholarly journals Diagnostic Accuracy of First and Early Second Trimester Multiple Biomarkers for Prediction of Gestational Diabetes Mellitus: A Multivariate Longitudinal Approach

2021 ◽  
Author(s):  
Elham Shaarbaf Eidgahi ◽  
Malihe Nasiri ◽  
Nourossadat Kariman ◽  
Nastaran Safavi Ardebili ◽  
Masoud Salehi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Repeated Measures ◽  
Early Prediction ◽  
Second Trimester ◽  
Multiple Indicators ◽  
Concurrent Use

Abstract Background Gestational Diabetes Mellitus (GDM) is an underlying cause of maternal and newborn morbidity and mortality all around the world. Timely diagnosis of GDM plays an important role in reducing its adverse consequences and burden. This study aimed to determine diagnostic accuracy of multiple indicators in complete blood count (CBC) test for early prediction of GDM. Methods In this prospective cohort study, the data from 600 pregnant women was analyzed. In the study sample, the two-step approach was utilized for the diagnosis of GDM at 24–28 weeks of gestation. We also used the repeated measures of hemoglobin (Hb), hematocrit (Hct), fasting blood sugar (FBS) and red blood cell count (RBC) in the first and early second trimesters of pregnancy as the longitudinal multiple indicators for early diagnosis of GDM. The classification of pregnant women to GDM and non-GDM groups was performed using a statistical technique based on the random-effects modeling framework. Results Among the sample, 49 women (8.2%) were diagnosed with GDM. In the first and early second trimester of pregnancy, the mean HcT, Hb and FBS of women with GDM was significantly higher than non-GDMs (P < 0.001). The concurrent use of multiple longitudinal data from HcT, Hb, RBC and FBS in the first and early second trimester of pregnancy resulted in a sensitivity, specificity and area under the curve (AUC) of 87%, 70% and 83%, respectively, for early prediction of GDM. Conclusions In general, our findings showed that the concurrent use of repeated measures data on Hct, Hb, FBS and RBC in the first and early second trimester of pregnancy might be utilized as an acceptable tool to predict GDM in the earlier stages.

scholarly journals Diagnostic accuracy of first and early second trimester multiple biomarkers for prediction of gestational diabetes mellitus: a multivariate longitudinal approach

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Elham Shaarbaf Eidgahi ◽  
Malihe Nasiri ◽  
Nourossadat Kariman ◽  
Nastaran Safavi Ardebili ◽  
Masoud Salehi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Repeated Measures ◽  
Early Prediction ◽  
Second Trimester ◽  
Multiple Indicators ◽  
Concurrent Use

Abstract Background Gestational Diabetes Mellitus (GDM) is an underlying cause of maternal and newborn morbidity and mortality all around the world. Timely diagnosis of GDM plays an important role in reducing its adverse consequences and burden. This study aimed to determine diagnostic accuracy of multiple indicators in complete blood count (CBC) test for early prediction of GDM. Methods In this prospective cohort study, the data from 600 pregnant women was analyzed. In the study sample, the two-step approach was utilized for the diagnosis of GDM at 24–28 weeks of gestation. We also used the repeated measures of hemoglobin (Hb), hematocrit (Hct), fasting blood sugar (FBS) and red blood cell count (RBC) in the first and early second trimesters of pregnancy as the longitudinal multiple indicators for early diagnosis of GDM. The classification of pregnant women to GDM and non-GDM groups was performed using a statistical technique based on the random-effects modeling framework. Results Among the sample, 49 women (8.2%) were diagnosed with GDM. In the first and early second trimester of pregnancy, the mean HcT, Hb and FBS of women with GDM was significantly higher than non-GDMs (P < 0.001). The concurrent use of multiple longitudinal data from HcT, Hb, RBC and FBS in the first and early second trimester of pregnancy resulted in a sensitivity, specificity and area under the curve (AUC) of 87%, 70% and 83%, respectively, for early prediction of GDM. Conclusions In general, our findings showed that the concurrent use of repeated measures data on Hct, Hb, FBS and RBC in the first and early second trimester of pregnancy might be utilized as an acceptable tool to predict GDM earlier in pregnancy.

scholarly journals Diagnostic accuracy of glycated hemoglobin for gestational diabetes mellitus: a systematic review and meta-analysis

2019 ◽  
Vol 57 (10) ◽  
pp. 1435-1449 ◽  
Author(s):  
Paula B. Renz ◽  
Fernando C. Chume ◽  
João R.T. Timm ◽  
Ana L. Pimentel ◽  
Joíza L. Camargo
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Glycated Hemoglobin ◽  
Meta Analysis ◽  
Individual Performance ◽  
Index Test

Abstract Background We conducted a systematic review and meta-analysis to establish the overall accuracy of glycated hemoglobin (HbA1c) in the diagnosis of gestational diabetes mellitus (GDM) diagnosis. Methods We searched MEDLINE, EMBASE, SCOPUS and ClinicalTrials.gov up to October 2018, using keywords related to GDM, HbA1c and diagnosis. Studies were included that were carried out with pregnant women without previous diabetes that assessed the performance of HbA1c (index test) compared to the 75 g oral glucose tolerance test (OGTT) (reference test) for the diagnosis of GDM, that measured HbA1c by standardized methods and presented data necessary for drawing 2 × 2 tables. Results This meta-analysis included eight studies, totaling 6406 pregnant women, of those 1044 had GDM. The diagnostic accuracy of HbA1c was reported at different thresholds ranging from 5.4% (36 mmol/mol) to 6.0% (42 mmol/mol), and the area under the curve (AUC) was 0.825 (95% confidence interval [CI] 0.751–0.899), indicating a good level of overall accuracy. The pooled sensitivities and specificities were 50.3% (95% CI 24.8%–75.7%) and 83.7% (67.5%–92.7%); 24.7% (10.3%–48.5%) and 95.5% (85.7%–98.7%); 10.8% (5.7%–19.41%) and 98.7% (96.2%–99.5%); 12.9% (5.5%–27.5%) and 98.7% (97.6%–99.3%), for the cut-offs of 5.4% (36 mmol/mol), 5.7% (39 mmol/mol), 5.8% (40 mmol/mol) and 6.0% (42 mmol/mol), respectively. Conclusions We observed a high heterogeneity among the studies. The effect of ethnicities, different criteria for OGTT interpretation and the individual performance of HbA1c methods may have contributed to this heterogeneity. The HbA1c test presents high specificity but low sensitivity regardless of the threshold used to diagnose GDM. These findings point to the usefulness of HbA1c as a rule-in test. HbA1c should be used in association with other standard diagnostic tests for GDM diagnosis.

scholarly journals Cost effectiveness of different screening strategies for gestational diabetes mellitus screening: study protocol of a randomized community non-inferiority trial

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Fahimeh Ramezani Tehrani ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Cost Effectiveness ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Standard Care ◽  
First Trimester ◽  
Trial Registration ◽  
Second Trimester

Abstract Background There is lack of ideal and comprehensive economic evaluations of various GDM strategies. The aim of this study is to the compare efficacy and cost-effectiveness of five different methods of screening for gestational diabetes mellitus (GDM). Methods This study is a randomized community non-inferiority trial among 30,000 pregnant women in five different geographic regions of Iran, who were randomly assigned to one of the five GDM screening methods. All first trimester pregnant women, seeking prenatal care in governmental health care systems, who met our eligibility criteria were enrolled. The criteria suggested by the International-Association-of-Diabetes-in-Pregnancy-Study-Group, the most intensive approach, were used as reference. We used the non-inferiority approach to compare less intensive strategies to the reference one. Along with routine prenatal standard care, all participants were scheduled to have two phases of GDM screening in first and second-trimester of pregnancy, based on five different pre-specified protocols. The screening protocol included fasting plasma glucose in the first trimester and either a one step or a two-step screening method in the second trimester of pregnancy. Pregnant women were classified in three groups based on the results: diagnosed with preexisting pre-gestational overt diabetes; gestational diabetes and non-GDM women. Each group received packages for standard-care and all participants were followed till delivery; pregnancy outcomes, quality of life and cost of health care were recorded in detail using specific standardized questionnaires. Primary outcomes were defined as % birth-weight > 90th percentile and primary cesarean section. In addition, we assessed the direct health care direct and indirect costs. Results This study will enable us to compare the cost effectiveness of different GDM screening protocols and intervention intensity (low versus high). Conclusion Results which if needed, will also enable policy makers to optimize the national GMD strategy as a resource for enhancing GDM guidelines. Trial registration Name of the registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT138707081281N1. Date of registration: 2017-02-15. URL of trial registry record: https://www.irct.ir/trial/518

scholarly journals FGF21 Serum Levels in the Early Second Trimester Are Positively Correlated With the Risk of Subsequent Gestational Diabetes Mellitus: A Propensity-Matched Nested Case-Control Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhiheng Wang ◽  
Min Yuan ◽  
Chengjie Xu ◽  
Yang Zhang ◽  
Chunmei Ying ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Case Control Study ◽  
Case Control ◽  
Fibroblast Growth Factor 21 ◽  
Second Trimester ◽  
Nested Case Control ◽  
Control Study

BackgroundAs an important endocrine hormone regulating glucose metabolism, fibroblast growth factor 21 (FGF21) is increased in individuals with gestational diabetes mellitus (GDM) after 24 gestational weeks. However, it is unknown whether the increase in FGF21 precedes the diagnosis of GDM.MethodsIn this nested case-control study, 133 pregnant women with GDM and 133 pregnant women with normal glucose tolerance (NGT) were identified through propensity score matching, and serum FGF21 levels were measured at 14 to 21 gestational weeks, before GDM is routinely identified. The differences in FGF21 levels were compared. The association between FGF21 and the occurrence of GDM was evaluated using logistic regression models with adjustment for confounders.ResultsThe serum FGF21 levels of the GDM group at 14 to 21 gestational weeks were significantly higher than those of the NGT group overall (P &lt; 0.001), with similar results observed between the corresponding BMI subgroups (P &lt; 0.05). The 2nd (OR 1.224, 95% CI 0.603–2.485), 3rd (OR 2.478, 1.229–5.000), and 4th (OR 3.419, 95% CI 1.626–7.188) FGF21 quartiles were associated with greater odds of GDM occurrence than the 1st quartile after multivariable adjustments.ConclusionsThe serum FGF21 levels in GDM groups increased in the early second trimester, regardless of whether participants were stratified according to BMI. After adjusting for confounding factors, the FGF21 levels in the highest quartile were associated with more than three times higher probability of the diagnosis of GDM in the pregnancy as compared to levels in the first quartile.

scholarly journals Higher mean amplitude of glycaemic excursion in the second trimester of pregnancy is associated with the subsequent development of gestational diabetes mellitus: an observational study

2021 ◽  
Author(s):  
Phaik Ling Quah ◽  
Kok Hian Tan ◽  
Nurul Razali ◽  
Nurul Sakinah Razali
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Gestational Diabetes ◽  
Observational Study ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Subsequent Development ◽  
Mean Amplitude ◽  
First Trimester ◽  
Second Trimester

Objective: To examine glycaemic variability (GV) and glycaemic control (GC) parameters in early pregnancy with subsequent development of gestational diabetes mellitus (GDM). Design: Longitudinal observational study. Setting: Pregnant women from KK Women and Children’s Hospital in Singapore Participants: 51 study participants in the first trimester (9-13 weeks’ gestational), and 44 participants (18-23 weeks’ gestation) in the second trimester of pregnancy. Methods: Independent t-tests were used to examine the differences in the parameters between participants who developed GDM and those who did not. Main outcome measure: GDM was determined at 24-30 weeks’ gestation using oral glucose tolerance test (OGTT). GV parameters examined were, mean amplitude of glycaemic excursion (MAGE), standard deviation of blood glucose (SDBG) and mean of daily continuous 24 h blood glucose (MBG) and coefficient of variation (CV). GC parameters measured were, J-Index and % time spent in glucose target ranges. Results: In the second trimester of pregnancy, mean amplitude of glycaemic excursions (MAGE) was significantly higher in participants who subsequently developed GDM, compared to those who did not (mean (SD): 3.18(0.68) vs 2.60(0.53), p=0.02). Other study parameters measured in the second trimester of pregnancy were not significantly different between groups. There were no significant associations between all the GV and GC parameters determined from the CGM in the first trimester with subsequent development of GDM (p>0.05). Conclusion: MAGE is an important GV parameter associated to the development of subsequent GDM in pregnant women. The findings highlight the potential value of CGM in gestational glycaemic profiling.

scholarly journals Higher Parity, Pre-Pregnancy BMI and Rate of Gestational Weight Gain Are Associated with Gestational Diabetes Mellitus in Food Insecure Women

2021 ◽  
Vol 18 (5) ◽  
pp. 2694
Author(s):  
Heng Yaw Yong ◽  
Zalilah Mohd Shariff ◽  
Barakatun Nisak Mohd Yusof ◽  
Zulida Rejali ◽  
Yvonne Yee Siang Tee ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Weight Gain ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Food Insecurity ◽  
Pregnant Women ◽  
Household Food Insecurity ◽  
Second Trimester ◽  
Gestational Weight ◽  
Household Food

Food insecurity may exacerbate adverse maternal health outcomes during pregnancy, however, this association has not been well established, particularly in the context of developing countries. This study aimed to identify the associations between household food insecurity and gestational diabetes mellitus (GDM) risk among urban pregnant women. Household food insecurity was assessed using the translated 10-item Radimer/Cornell hunger scale. Logistic regression models were used to estimate the associations between food insecurity status and GDM risk. About 35.6% of women experienced food insecurity, with 25.2% reported household food insecurity, 8.0% individual food insecurity, and 2.4% child hunger. Food insecure women were at significantly higher risk of developing GDM compared to food secure women (AOR = 16.65, 95% CI = 6.17–24.98). The significant association between food insecurity and GDM risk was influenced by pre-pregnancy BMI, parity and rate of GWG at second trimester. Food insecure women with parity ≥ 2 (AOR = 4.21, 95% CI = 1.98–8.92), overweight/obese BMI prior to pregnancy (AOR = 12.11, 95% CI = 6.09–24.10) and excessive rate of GWG in the second trimester (AOR = 9.66, 95% CI = 4.27–21.83) were significantly more likely to develop GDM compared to food secure women. Food insecurity showed strong association with GDM risk in that the association was influenced by maternal biological and physical characteristics. Multipronged interventions may be necessary for food insecure pregnant women who are not only at risk of overweight/obesity prior to pregnancy but also may have excessive gestational weight gain, in order to effectively reduce GDM risk.

scholarly journals Gestational diabetes mellitus prediction model: A risk factors analysis of pregnant women with gestational diabetes mellitus but have normal oral glucose tolerance test results in the second trimester of pregnancy

2021 ◽  
Vol 29 ◽  
pp. 57-63
Author(s):  
Jiayu Lu ◽  
Song Zhang ◽  
Hongqing Jiang ◽  
Lin Yang ◽  
Dongmei Hao ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Glucose Tolerance Test ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Second Trimester ◽  
Oral Glucose Tolerance

BACKGROUND: Oral glucose tolerance test (OGTT) is a standard for the diagnosis of gestational diabetes mellitus (GDM). However, clinically, some cases with normal results were diagnosed as GDM in the third trimester. OBJECTIVE: To establish a risk model based on energy metabolism, epidemiology, and biochemistry that could predict the GDM pregnant women with normal OGTT results in the second trimester. METHODS: Qualitative and quantitative data were analyzed to find out the risk factors, and the binary logistic backward LR regression was used to establish the prediction model of each factor and comprehensive factor, respectively. RESULTS: The risk factors including the rest energy expenditure per kilogram of body weight, oxygen consumption per kilogram of body weight, if more than the weight gain criteria of the Institute of Medicine, the increase of body mass index between the second trimester and pre-pregnancy, and fasting blood glucose. By comparison, the comprehensive model had the best prediction performance, indicating that 85% of high-risk individuals were correctly classified. CONCLUSION: Energy metabolism, epidemiology, and biochemistry had better recognition ability for the GDM pregnant women with normal OGTT results in the second trimester. The addition of metabolic factors in the second trimester also improved the overall prediction performance.

scholarly journals Correlation of serum biomarkers in prediction of gestational diabetes mellitus

2017 ◽  
Vol 6 (10) ◽  
pp. 4402
Author(s):  
Maya Menon ◽  
M. Alaganandha ◽  
Jayanthi Mohan
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
First Trimester ◽  
Study Groups ◽  
Serum Biomarkers ◽  
P Value ◽  
Second Trimester ◽  
The Difference

Background: Adiponectin and Leptin are adipokines produced by adipocytes. TNF-alpha and IL-6 are inflammatory cytokines which increases insulin resistance. Decreased adiponectin, increased leptin, TNF-alpha and IL-6 is associated with risk of Gestational Diabetes Mellitus, characterised by glucose intolerance that begins or first recognised in pregnancy leading to maternal and foetal complications. India has a high prevalence of GDM upto 16.55% by (2hr plasma glucose of more than 140mg/dl). We aimed to evaluate whether ‘First trimester serum biomarkers predict gestational diabetes mellitus’. The objective of the study was to study the serum biomarkers levels in early pregnancy and predict the risk of developing gestational diabetes mellitus. To study the correlation of serum biomarkers levels in gestational diabetes mellitus.Methods: The study was conducted between October 2014 to March 2016 in healthy pregnant women aged 20-35 yrs attending the antenatal OPD in ESIC Hospital. Study design: Prospective observational study with three study groups 1. NGT, 2. GDM1, 3. GDM2 with two-time points one at first trimester and other second trimester. Sample size: 125 pregnant women. Work plan: Demographics, baseline characteristics and other clinical risk factors of pregnant women in 1st trimester who consented for the study, meeting the inclusion criteria are noted. 75 gm OGCT (oral glucose challenge test) done at two-time points first and second trimester in the study groups will be analysed using the DIPSI criteria with a cut-off value ≥140mg/dl and divided into 3 groups. Serum biomarkers were measured by DRG ELISA method at one-time point in first trimester in all the 3 groups.Results: The serum levels of adiponectin are comparatively reduced in first trimester GDM1 group. As the difference was not significant with p-value of 0.33 there was no correlation between adiponectin and GDM in our study. Serum leptin is increased in second trimester GDM group but the difference is insignificant with a p value of 0.11 showing no correlation.Conclusions: Among the cytokines IL-6 also shows an increasing tendency in both GDM1 (5.9±0.57) and GDM2 (6.04±1.04) groups compared to the NGT (5.82±0.38) group. Serum TNFα is increased in GDM1 (17.29±17.14) and NGT (17.03±24.03) compared to GDM2 (13.54±17.29) group. 

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