Case Control Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 864-873
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.864
Study on the correlation and predictive value of serum pregnancy-associated plasma protein A, triglyceride and serum 25-hydroxyvitamin D levels with gestational diabetes mellitus
Zhuo Ren, Dong Zhe, Zhi Li, Xin-Ping Sun, Kai Yang, Li Lin
Zhuo Ren, Dong Zhe, Zhi Li, Kai Yang, Li Lin, Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
Xin-Ping Sun, Department of Clinical Laboratory, Peking University International Hospital, Beijing 102206, China
Author contributions: Ren Z and Dong Z designed the research; Li Z performed the research; Sun XP analyzed the data; Yang K and Li L wrote the paper. Ren Z and Dong Z contributed equally to this work.
Institutional review board statement: This study was reviewed and approved by the Peking University International Hospital Ethics Committee.
Informed consent statement: All patients in our study provided informed consent.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li Lin, PhD, Chief Physician, Department of Obstetrics and Gynecology, Peking University International Hospital, No. 1, Life Garden Road, Zhongguancun Life Park, Changping District, Beijing 102206, China. lingdanhu4@163.com
Received: November 26, 2019
Peer-review started: November 26, 2019
First decision: December 30, 2019
Revised: January 6, 2020
Accepted: February 10, 2020
Article in press: February 10, 2020
Published online: March 6, 2020
ARTICLE HIGHLIGHTS
Research background

Gestational diabetes mellitus (GDM) refers to gestational secretory diseases that occur during pregnancy with varying degrees of abnormal glucose metabolism, but with blood glucose levels that do not meet the criteria for dominant diabetes. Early treatment is more effective, and there is currently a lack of indicators for predicting GDM. Therefore, it is very important to identify new indicators for the diagnosis and treatment of GDM.

Research motivation

Serum pregnancy-associated protein A (PAPP-A) levels in early pregnancy have high sensitivity and specificity for pregnancy complications such as spontaneous abortion and hypertension. Elevated triglyceride (TG) levels can increase insulin resistance and promote islet β-cell apoptosis. Serum 25-hydroxyvitamin D [25-(OH)D] has been found to show a downward trend in type 2 diabetes, and has the effect of enhancing insulin sensitivity and improving insulin resistance. However, research on the role and mechanism of these three factors in GDM is rare, and PAPP-A, TG, and 25-(OH)D may have important effects in predicting GDM.

Research objectives

The purpose of this investigation was to investigate the correlation and predictive value of serum PAPP-A, TG, and serum 25-(OH)D levels in GDM during early pregnancy.

Research methods

Ninety-nine patients in early pregnancy were admitted to our hospital from November 2015 to September 2017 and their fasting blood glucose was determined. Group A consisted of 51 cases with GDM who were screened using the oral glucose tolerance test at 24-28 wk. Forty-eight women without GDM were included in group B. The serum PAPP-A, TG, and 25-(OH)D levels were compared between the two groups and their correlation with blood glucose was analyzed. In addition, the diagnostic value of PAPP-A, TG, and 25-(OH)D levels in GDM was determined using ROC curve analysis.

Research results

Serum PAPP-A and 25-(OH)D levels in group A were significantly lower than those in group B, and the TG levels in group A were significantly higher than those in group B. The differences were statistically significant (P < 0.05). Pearson analysis showed that PAPP-A, 25-(OH)D and fasting blood glucose levels were negatively correlated (r = -0.605, P < 0.001), (r = -0.597, P < 0.001), and TG and fasting blood glucose levels were positively correlated (r = 0.628, P < 0.001). The sensitivity of serum PAPP-A level in diagnosing GDM was 72.55%, the specificity was 82.35%, the AUC was 0.861, and the optimal cut-off was 16.340. The sensitivity of TG level in diagnosing GDM was 86.27%, the specificity was 66.67%, and the AUC was 0.813, and the best cut-off value was 1.796. 25-(OH)D level had a sensitivity of 64.71%, specificity of 70.59%, AUC of 0.721, and the best cut-off value was 23.140. Multivariate logistic regression analysis showed that fasting blood glucose during pregnancy, vascular endothelial growth factor, Flt-1, serum PAPP-A, TG, and 25-(OH)D are all related risk factors for GDM.

Research conclusions

Serum PAPP-A, TG and 25-(OH)D levels are related to changes in GDM blood glucose, and are independent factors affecting the occurrence of GDM.

Research perspectives

Serum PAPP-A, TG and 25-(OH)D levels were correlated with changes in GDM blood glucose, and are independent factors affecting the occurrence of GDM. The clinical determination of serum PAPP-A, TG, and 25-(OH)D levels will help to formulate a treatment plan for GDM.