Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
ISSN
1437-4331
See all formats and pricing
More options …
Volume 54, Issue 3

Issues

Early prediction of gestational diabetes: a practical model combining clinical and biochemical markers

Sébastien Thériault
  • CHU de Québec Research Center, Quebec City, QC, Canada
  • Département de Biologie Moléculaire, Biochimie Médicale et Pathologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Yves Giguère
  • CHU de Québec Research Center, Quebec City, QC, Canada
  • Département de Biologie Moléculaire, Biochimie Médicale et Pathologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jacques Massé
  • CHU de Québec Research Center, Quebec City, QC, Canada
  • Département de Biologie Moléculaire, Biochimie Médicale et Pathologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joël Girouard
  • CHU de Québec Research Center, Quebec City, QC, Canada
  • Département de Biologie Moléculaire, Biochimie Médicale et Pathologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jean-Claude Forest
  • Corresponding author
  • CHU de Québec Research Center, Quebec City, QC, Canada
  • Département de Biologie Moléculaire, Biochimie Médicale et Pathologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2015-08-06 | DOI: https://doi.org/10.1515/cclm-2015-0537

Abstract

Background: Gestational diabetes (GDM) is usually diagnosed late in pregnancy, precluding early preventive interventions. This study aims to develop a predictive model based on clinical factors and selected biochemical markers for the early risk assessment of GDM.

Methods: Based on a prospective cohort of 7929 pregnant women from the Quebec City metropolitan area, a nested case-control study was performed including 264 women who developed GDM. Each woman who developed GDM was matched with two women with normal glycemic profile. Risk prediction models for GDM and GDM requiring insulin therapy were developed using multivariable logistic regression analyses, based on clinical characteristics and the measurement of three clinically validated biomarkers: glycated hemoglobin (HbA1c), sex hormone binding globulin (SHBG) and high-sensitivity C-reactive protein (hsCRP) measured between 14 and 17 weeks of gestation.

Results: HbA1c and hsCRP were higher and SHBG was lower in women who developed GDM (p<0.001). The selected model for the prediction of GDM, based on HbA1c, SHBG, BMI, past history of GDM, family history of diabetes and soft drink intake before pregnancy yielded an area under the ROC curve (AUC) of 0.79 (0.75–0.83). For the prediction of GDM requiring insulin therapy, the selected model including the same six variables yielded an AUC of 0.88 (0.84–0.92) and a sensitivity of 68.9% at a false-positive rate of 10%.

Conclusions: A simple model based on clinical characteristics and biomarkers available early in pregnancy could allow the identification of women at risk of developing GDM, especially GDM requiring insulin therapy.

Keywords: biomarkers; early pregnancy; gestational diabetes; model

References

  • 1.

    Landon MB, Gabbe SG. Gestational diabetes mellitus. Obstet Gynecol 2011;118:1379–93.CrossrefGoogle Scholar

  • 2.

    Schneider S, Bock C, Wetzel M, Maul H, Loerbroks A. The prevalence of gestational diabetes in advanced economies. J Perinat Med 2012;40:511–20.CrossrefWeb of ScienceGoogle Scholar

  • 3.

    Donovan L, Hartling L, Muise M, Guthrie A, Vandermeer B, Dryden DM. Screening tests for gestational diabetes: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2013;159:115–22.CrossrefWeb of ScienceGoogle Scholar

  • 4.

    Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676–82.Web of ScienceCrossrefGoogle Scholar

  • 5.

    National Institutes of Health consensus development conference statement: diagnosing gestational diabetes mellitus, March 4–6, 2013. Obstetr Gynecol 2013;122:358–69.Google Scholar

  • 6.

    Thompson D, Berger H, Feig D, Gagnon R, Kader T, Keely E, et al. Diabetes and pregnancy. Can J Diabetes 2013;37(Suppl 1):S168–83.CrossrefGoogle Scholar

  • 7.

    American Diabetes Association. Standards of medical care in diabetes – 2014. Diabetes Care 2014;37(Suppl 1):S14–80.Web of ScienceGoogle Scholar

  • 8.

    Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract 2014;103:341–63.Web of SciencePubMedGoogle Scholar

  • 9.

    Beucher G, Viaris de Lesegno B, Dreyfus M. Maternal outcome of gestational diabetes mellitus. Diabetes Metab 2010;36:522–37.CrossrefWeb of ScienceGoogle Scholar

  • 10.

    Mitanchez D. Foetal and neonatal complications in gestational diabetes: perinatal mortality, congenital malformations, macrosomia, shoulder dystocia, birth injuries, neonatal complications. Diabetes Metab 2010;36:617–27.Web of ScienceCrossrefGoogle Scholar

  • 11.

    Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991–2002.Google Scholar

  • 12.

    Burguet A. Long-term outcome in children of mothers with gestational diabetes. Diabetes Metab 2010;36:682–94.Web of ScienceCrossrefGoogle Scholar

  • 13.

    Verier-Mine O. Outcomes in women with a history of gestational diabetes. Screening and prevention of type 2 diabetes. Literature review. Diabetes Metab 2010;36:595–616.Web of ScienceGoogle Scholar

  • 14.

    Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;352:2477–86.Google Scholar

  • 15.

    Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339–48.Web of ScienceGoogle Scholar

  • 16.

    Maher N, McAuliffe F, Foley M. The benefit of early treatment without rescreening in women with a history of gestational diabetes. J Matern Fetal Neonatal Med 2013;26:318–20.CrossrefGoogle Scholar

  • 17.

    Thangaratinam S, Rogozinska E, Jolly K, Glinkowski S, Roseboom T, Tomlinson JW, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. Br Med J 2012;344:e2088.Web of ScienceGoogle Scholar

  • 18.

    Oostdam N, van Poppel MN, Wouters MG, van Mechelen W. Interventions for preventing gestational diabetes mellitus: a systematic review and meta-analysis. J Women Health 2011;20:1551–63.CrossrefGoogle Scholar

  • 19.

    Caliskan E, Kayikcioglu F, Ozturk N, Koc S, Haberal A. A population-based risk factor scoring will decrease unnecessary testing for the diagnosis of gestational diabetes mellitus. Acta Obstet Gynecol Scand 2004;83:524–30.CrossrefGoogle Scholar

  • 20.

    Naylor CD, Sermer M, Chen E, Farine D. Selective screening for gestational diabetes mellitus. Toronto Trihospital Gestational Diabetes Project Investigators. N Engl J Med 1997;337:1591–6.Google Scholar

  • 21.

    Teede HJ, Harrison CL, Teh WT, Paul E, Allan CA. Gestational diabetes: development of an early risk prediction tool to facilitate opportunities for prevention. Aust N Z J Obstet Gynaecol 2011;51:499–504.Web of ScienceGoogle Scholar

  • 22.

    van Leeuwen M, Opmeer BC, Zweers EJ, van Ballegooie E, ter Brugge HG, de Valk HW, et al. Estimating the risk of gestational diabetes mellitus: a clinical prediction model based on patient characteristics and medical history. Br J Obstet Gynaecol 2010;117:69–75.CrossrefGoogle Scholar

  • 23.

    Theriault S, Forest JC, Masse J, Giguere Y. Validation of early risk-prediction models for gestational diabetes based on clinical characteristics. Diabetes Res Clin Pract 2014;103:419–25.CrossrefWeb of ScienceGoogle Scholar

  • 24.

    Blachier A, Alberti C, Korb D, Schmitz T, Patrick V, Christine B, et al. Diet or medically treated gestational diabetes: is there any difference for obstetrical and neonatal complications? A French cohort study. J Perinat Med 2014;42:315–9.CrossrefWeb of ScienceGoogle Scholar

  • 25.

    Ferreira AF, Rezende JC, Vaikousi E, Akolekar R, Nicolaides KH. Maternal serum visfatin at 11–13 weeks of gestation in gestational diabetes mellitus. Clin Chem 2011;57:609–13.CrossrefWeb of ScienceGoogle Scholar

  • 26.

    Nanda S, Savvidou M, Syngelaki A, Akolekar R, Nicolaides KH. Prediction of gestational diabetes mellitus by maternal factors and biomarkers at 11 to 13 weeks. Prenatal Diagn 2011;31: 135–41.Web of ScienceCrossrefGoogle Scholar

  • 27.

    Savvidou M, Nelson SM, Makgoba M, Messow CM, Sattar N, Nicolaides K. First-trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures. Diabetes 2010;59:3017–22.Web of ScienceCrossrefGoogle Scholar

  • 28.

    Lovati E, Beneventi F, Simonetta M, Laneri M, Quarleri L, Scudeller L, et al. Gestational diabetes mellitus: including serum pregnancy-associated plasma protein-A testing in the clinical management of primiparous women? A case-control study. Diabetes Res Clin Pract 2013;100:340–7.CrossrefWeb of ScienceGoogle Scholar

  • 29.

    Leipold H, Worda C, Ozbal A, Husslein P, Krampl E. First-trimester nuchal translucency screening in pregnant women who subsequently developed gestational diabetes. J Soc Gynecol Invest 2005;12:529–32.CrossrefGoogle Scholar

  • 30.

    Qiu C, Sorensen TK, Luthy DA, Williams MA. A prospective study of maternal serum C-reactive protein (CRP) concentrations and risk of gestational diabetes mellitus. Paediatr Perinat Epidemiol 2004;18:377–84.CrossrefGoogle Scholar

  • 31.

    Caglar GS, Ozdemir ED, Cengiz SD, Demirtas S. Sex-hormone-binding globulin early in pregnancy for the prediction of severe gestational diabetes mellitus and related complications. J Obstetr Gynaecol Res 2012;38:1286–93.CrossrefGoogle Scholar

  • 32.

    Fong A, Serra AE, Gabby L, Wing DA, Berkowitz KM. Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus. Am J Obstet Gynecol 2014;211:641.e1–7.Google Scholar

  • 33.

    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008;32(Suppl 1):S1–201.Google Scholar

  • 34.

    Chen L, Hu FB, Yeung E, Willett W, Zhang C. Prospective study of pre-gravid sugar-sweetened beverage consumption and the risk of gestational diabetes mellitus. Diabetes Care 2009;32: 2236–41.Web of ScienceCrossrefGoogle Scholar

  • 35.

    Zhang C, Solomon CG, Manson JE, Hu FB. A prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med 2006;166:543–8.CrossrefGoogle Scholar

  • 36.

    Sauerbrei W. The use of resampling methods to simplify regression models in medical statistics. J Royal Stat Soc Series C 1999;48:313–29.CrossrefGoogle Scholar

  • 37.

    DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 1988;44:837–45.CrossrefGoogle Scholar

  • 38.

    Savona-Ventura C, Vassallo J, Marre M, Karamanos BG. A composite risk assessment model to screen for gestational diabetes mellitus among Mediterranean women. Int J Gynaecol Obstet 2013;120:240–4.CrossrefGoogle Scholar

  • 39.

    Walker JD. NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabet Med 2008;25:1025–7.Google Scholar

  • 40.

    Avalos GE, Owens LA, Dunne F. Applying current screening tools for gestational diabetes mellitus to a European population: is it time for change? Diabetes Care 2013;36:3040–4.Web of ScienceCrossrefGoogle Scholar

  • 41.

    Mosca A, Paleari R, Dalfra MG, Di Cianni G, Cuccuru I, Pellegrini G, et al. Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study. Clin Chem 2006;52:1138–43.CrossrefGoogle Scholar

  • 42.

    Hughes RC, Moore MP, Gullam JE, Mohamed K, Rowan J. An early pregnancy HbA1c >/=5.9% (41 mmol/mol) is optimal for detecting diabetes and identifies women at increased risk of adverse pregnancy outcomes. Diabetes Care 2014;37:2953–9.Web of ScienceGoogle Scholar

  • 43.

    Peter A, Kantartzis K, Machann J, Schick F, Staiger H, Machicao F, et al. Relationships of circulating sex hormone-binding globulin with metabolic traits in humans. Diabetes 2010;59:3167–73.Web of ScienceCrossrefGoogle Scholar

  • 44.

    Watanabe N, Morimoto S, Fujiwara T, Suzuki T, Taniguchi K, Mori F, et al. Prediction of gestational diabetes mellitus by soluble (pro)renin receptor during the first trimester. J Clin Endocrinol Metab 2013;98:2528–35.CrossrefWeb of ScienceGoogle Scholar

  • 45.

    Rasanen JP, Snyder CK, Rao PV, Mihalache R, Heinonen S, Gravett MG, et al. Glycosylated fibronectin as a first-trimester biomarker for prediction of gestational diabetes. Obstetr Gynecol 2013;122:586–94.CrossrefGoogle Scholar

  • 46.

    Maitland RA, Seed PT, Briley AL, Homsy M, Thomas S, Pasupathy D, et al. Prediction of gestational diabetes in obese pregnant women from the UK Pregnancies Better Eating and Activity (UPBEAT) pilot trial. Diabet Med 2014;31:963–70.CrossrefGoogle Scholar

  • 47.

    Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Aust N Z J Obstet Gynaecol 2011;51:432–6.Web of ScienceGoogle Scholar

  • 48.

    Halperin IJ, Feig DS. The role of lifestyle interventions in the prevention of gestational diabetes. Curr Diabetes Rep 2014;14:452.Web of ScienceCrossrefGoogle Scholar

About the article

Corresponding author: Jean-Claude Forest, MD, PhD, FRCPC, CHU de Québec Research Center, 10, rue de l’Espinay, Quebec City, QC G1L 3L5, Canada, Phone: +1 418 525 4444 ext. 54438, Fax: +1 418 525 4195, E-mail: ; and Département de Biologie Moléculaire, Biochimie Médicale et Pathologie, Faculté de Médecine, Université Laval, Quebec City, QC, Canada


Received: 2015-06-09

Accepted: 2015-07-09

Published Online: 2015-08-06

Published in Print: 2016-03-01


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 54, Issue 3, Pages 509–518, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2015-0537.

Export Citation

©2016 by De Gruyter.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
Damien Bouvier, Jean-Claude Forest, Emilie Dion-Buteau, Nathalie Bernard, Emmanuel Bujold, Bruno Pereira, and Yves Giguère
Journal of Clinical Medicine, 2019, Volume 8, Number 12, Page 2074
[2]
Shahla Faal, Parvin Abedi, Shayesteh Jahanfar, Jonas Mayoke Ndeke, Zeynab Mohaghegh, Foruzan Sharifipour, and Maryam Zahedian
Diabetes Research and Clinical Practice, 2019, Volume 152, Page 39
[3]
Nathalie Bernard, Jean-Claude Forest, George M. Tarabulsy, Emmanuel Bujold, Damien Bouvier, and Yves Giguère
BMC Pregnancy and Childbirth, 2019, Volume 19, Number 1
[4]
Tina Ravnsborg, Sarah Svaneklink, Lise Lotte T. Andersen, Martin R. Larsen, Dorte M. Jensen, Martin Overgaard, and Víctor Sánchez-Margalet
PLOS ONE, 2019, Volume 14, Number 3, Page e0214457
[5]
Arianne N. Sweeting, Jencia Wong, Heidi Appelblom, Glynis P. Ross, Heikki Kouru, Paul F. Williams, Mikko Sairanen, and Jon A. Hyett
Fetal Diagnosis and Therapy, 2019, Volume 45, Number 2, Page 76
[6]
Emilia Huvinen, Johan G. Eriksson, Beata Stach-Lempinen, Aila Tiitinen, and Saila B. Koivusalo
Acta Diabetologica, 2018
[7]
Stefanie N. Hinkle, Michael Y. Tsai, Shristi Rawal, Paul S. Albert, and Cuilin Zhang
Scientific Reports, 2018, Volume 8, Number 1
[8]
Arianne N. Sweeting, Heidi Appelblom, Glynis P. Ross, Jencia Wong, Heikki Kouru, Paul F. Williams, Mikko Sairanen, and Jon A. Hyett
Diabetes Research and Clinical Practice, 2017, Volume 127, Page 44
[9]
Camille E. Powe
Current Diabetes Reports, 2017, Volume 17, Number 2
[10]
Erica K. Berggren, Kim A. Boggess, Leny Mathew, and Jennifer Culhane
Reproductive Sciences, 2017, Volume 24, Number 4, Page 613
[11]
Sara L. White, Debbie A. Lawlor, Annette L. Briley, Keith M. Godfrey, Scott M. Nelson, Eugene Oteng-Ntim, Stephen C. Robson, Naveed Sattar, Paul T. Seed, Matias C. Vieira, Paul Welsh, Melissa Whitworth, Lucilla Poston, Dharmintra Pasupathy, and Dorit Samocha-Bonet
PLOS ONE, 2016, Volume 11, Number 12, Page e0167846

Comments (0)

Please log in or register to comment.
Log in