Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2024; 15(5): 914-922
Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.914
Associations of serum D-dimer and glycosylated hemoglobin levels with third-trimester fetal growth restriction in gestational diabetes mellitus
Ying Zhang, Teng Li, Chao-Yan Yue, Yun Liu
Ying Zhang, Chao-Yan Yue, Department of Laboratory Medicine, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China
Teng Li, Department of Interventional Radiology, The People’s Hospital of Weifang City, Weifang 261041, Shandong Province, China
Yun Liu, Department of Hematology, The People’s Hospital of Weifang City, Weifang 261041, Shandong Province, China
Author contributions: Zhang Y conceived and designed the study; Liu Y guided the study; Zhang Y and Liu Y collected the clinical date; Li T and Yue CY analyzed the data; all authors drafted and revised the manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Obstetrics and Gynecology Hospital of Fudan University, Approval No. 2019-06.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yun Liu, MM, Doctor, Department of Hematology, The People’s Hospital of Weifang City, No. 151 Guangwen Street, Kuiwen District, Weifang 261041, Shandong Province, China. yun.1100@163.com
Received: January 5, 2024
Peer-review started: January 5, 2024
First decision: January 27, 2024
Revised: February 24, 2024
Accepted: March 15, 2024
Article in press: March 15, 2024
Published online: May 15, 2024
Processing time: 126 Days and 3.3 Hours
Abstract
BACKGROUND

Gestational diabetes mellitus (GDM) is a special type of diabetes that commonly occurs in women during pregnancy and involves impaired glucose tolerance and abnormal glucose metabolism; GDM is diagnosed for the first time during pregnancy and can affect fetal growth and development.

AIM

To investigate the associations of serum D-dimer (D-D) and glycosylated hemoglobin (HbA1c) levels with third-trimester fetal growth restriction (FGR) in GDM patients.

METHODS

The clinical data of 164 pregnant women who were diagnosed with GDM and delivered at the Obstetrics and Gynecology Hospital of Fudan University from January 2021 to January 2023 were analyzed retrospectively. Among these women, 63 whose fetuses had FGR were included in the FGR group, and 101 women whose fetuses had normal body weights were included in the normal body weight group (normal group). Fasting venous blood samples were collected from the elbow at 28-30 wk gestation and 1-3 d before delivery to measure serum D-D and HbA1c levels for comparative analysis. The diagnostic value of serum D-D and HbA1c levels for FGR was evaluated by receiver operating characteristic analysis, and the influencing factors of third-trimester FGR in GDM patients were analyzed by logistic regression.

RESULTS

Serum fasting blood glucose, fasting insulin, D-D and HbA1c levels were significantly greater in the FGR group than in the normal group, while the homeostasis model assessment of insulin resistance values were lower (P < 0.05). Regarding the diagnosis of FGR based on serum D-D and HbA1c levels, the areas under the curves (AUCs) were 0.826 and 0.848, the cutoff values were 3.04 mg/L and 5.80%, the sensitivities were 81.0% and 79.4%, and the specificities were 88.1% and 87.1%, respectively. The AUC of serum D-D plus HbA1c levels for diagnosing FGR was 0.928, and the sensitivity and specificity were 84.1% and 91.1%, respectively. High D-D and HbA1c levels were risk factors for third-trimester FGR in GDM patients (P < 0.05).

CONCLUSION

D-D and HbA1c levels can indicate the occurrence of FGR in GDM patients in the third trimester of pregnancy to some extent, and their combination can be used as an important index for the early prediction of FGR.

Keywords: Gestational diabetes mellitus; D-dimer; Hemoglobin; Fetal growth restriction; Fasting blood glucose

Core Tip: Pregnancy causes metabolic and immune changes, which may contribute to the development of gestational diabetes mellitus (GDM). Fetal growth restriction (FGR) is a common pregnancy complication, combined with GDM may lead to adverse perinatal outcomes, such as very low birth weight, seriously endangering perinatal life. Some serum markers may be associated with the predicted outcome. This study is to investigate the association of serum D-dimer and glycosylated hemoglobin levels with third-trimester FGR in GDM patients.