Potential Biomarkers in Early Pregnancy for Predicting Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes

Background: Gestational diabetes mellitus (GDM) is typically diagnosed based on a 75-g oral glucose tolerance test conducted at 24 - 28 weeks of pregnancy. A method for earlier diagnosis is needed. The present study aimed to identify one or more blood biomarkers detected within the first trimester that can predict the occurrence of GDM and pregnancy outcome. Methods: This retrospective study included 2,116 pregnant women who underwent examination and delivery in our hospital between January 2018 and December 2019. The predictive value of various clinical measurements in early pregnancy for predicting GDM and pregnancy outcome was analyzed. Results: The fasting plasma glucose (FPG), vitamin A, vitamin E, glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), uric acid, free thyroxine (FT3), anti-peroxidase antibody (TPOAb), and ferritin levels differed significantly between the GDM and non-GDM groups (all p < 0.05). The area under the receiver operating characteristic curve for FPG in GDM diagnosis was 0.766 (95% confidence interval [CI] 0.717 - 0.814, p < 0.001). The odds ratios (ORs) for FPG and TG for GDM prediction were 1.318 (95% CI 1.228 - 1.416) and 2.050 (95% CI 1.203 - 3.493), respectively. The ORs for FPG, vitamin A, and vitamin E for pregnancy outcome prediction were 1.214 (95% CI 1.123 - 1.268), 0.717 (95% CI 0.601 - 0.886), and 0.852 (95% CI 0.761 - 0.954), respectively. Conclusions: Screening of blood biomarkers in early pregnancy may be useful for predicting, and thus preventing, GDM and adverse pregnancy outcomes. Immediate intervention is recommended if an elevated FPG (> 4.7 mmol/L) or TG (> 1.83 mmol/L) level is detected in early pregnancy, and vitamin A, vitamin E, and FT3 levels need to be maintained within normal ranges throughout pregnancy.