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Fetal Diagn Ther. 2019;45(2):76-84. doi: 10.1159/000486853. Epub 2018 Jun 13.

A Novel Early Pregnancy Risk Prediction Model for Gestational Diabetes Mellitus.

Author information

1
Royal Prince Alfred Hospital, Diabetes Centre, Sydney, New South Wales, Australiaarianne.sweeting@sydney.edu.au.
2
Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australiaarianne.sweeting@sydney.edu.au.
3
Royal Prince Alfred Hospital, Diabetes Centre, Sydney, New South Wales, Australia.
4
Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
5
Department of Clinical Biochemistry, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
6
Diagnostics, PerkinElmer, Turku, Finland.
7
Royal Prince Alfred Hospital, Department of High Risk Obstetrics, Sydney, New South Wales, Australia.

Abstract

INTRODUCTION:

Accurate early risk prediction for gestational diabetes mellitus (GDM) would target intervention and prevention in women at the highest risk. We evaluated novel biomarker predictors to develop a first-trimester risk prediction model in a large multiethnic cohort.

METHODS:

Maternal clinical, aneuploidy and pre-eclampsia screening markers (PAPP-A, free hCGβ, mean arterial pressure, uterine artery pulsatility index) were measured prospectively at 11-13+6 weeks' gestation in 980 women (248 with GDM; 732 controls). Nonfasting glucose, lipids, adiponectin, leptin, lipocalin-2, and plasminogen activator inhibitor-2 were measured on banked serum. The relationship between marker multiples-of-the-median and GDM was examined with multivariate regression. Model predictive performance for early (< 24 weeks' gestation) and overall GDM diagnosis was evaluated by receiver operating characteristic curves.

RESULTS:

Glucose, triglycerides, leptin, and lipocalin-2 were higher, while adiponectin was lower, in GDM (p < 0.05). Lipocalin-2 performed best in Caucasians, and triglycerides in South Asians with GDM. Family history of diabetes, previous GDM, South/East Asian ethnicity, parity, BMI, PAPP-A, triglycerides, and lipocalin-2 were significant independent GDM predictors (all p < 0.01), achieving an area under the curve of 0.91 (95% confidence interval [CI] 0.89-0.94) overall, and 0.93 (95% CI 0.89-0.96) for early GDM, in a combined multivariate prediction model.

CONCLUSIONS:

A first-trimester risk prediction model, which incorporates novel maternal lipid markers, accurately identifies women at high risk of GDM, including early GDM.

KEYWORDS:

Gestational diabetes mellitus; Novel biomarkers; Prediction model; Risk stratification

PMID:
29898442
DOI:
10.1159/000486853
[Indexed for MEDLINE]

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