Association and Predictive Value of Maternal Serum C1q/Tumor Necrosis Factor-related Protein-3 Ratio with Gestational Diabetes Mellitus in Early Pregnancy: a Prospective Study

Abstract

Background Gestational diabetes mellitus (GDM) is characterized by increased insulin resistance. As serum complement C1q/tumor necrosis factor-related protein 3 (CTRP3) ratio is closely related to insulin resistance, which may be involved in the development of GDM. However, the association and predictive value of serum CTRP3 ratio with GDM in early pregnancy have been rarely reported. Objective To explore the association and predictive value of serum CTRP3 ratio with GDM in early pregnancy, providing new ideas for the prevention and treatment of GDM. Methods Women in early pregnancy who underwent regular obstetric examinations in Obstetric Clinic, Affiliated Hospital of Chengde Medical University, were prospectively and consecutively enrolled from June 2018 to March 2019. Demographics, fasting plasma glucose (FPG) , fasting insulin (FINS) , glycosylated hemoglobin (HbA1c) , triglyceride (TG) , total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) and serum CTRP3 ratio measured at 6-14 weeks of gestation were collected. The 75 g oral glucose tolerance test (OGTT) was performed to screen GDM at 24-28 weeks of gestation. The patients were divided into GDM group and normal glucose tolerance (NGT) group. Results Finally, 368 of the 393 cases were enrolled for analysis, including 81 (22.0%) who were detected with GDM by the 75 g OGTT. Compared with those with normal glucose tolerance (NGT) diagnosed by the 75 g OGTT, GDM cases had much greater average age, pre-pregnancy BMI, FPG, FINS, HbA1c, and TG (P<0.05) . Serum CTRP3 ratio in GDM group was lower than that in NGT group〔0.528 0 (0.461 3, 0.634 0) μg/L vs 0.604 8 (0.510 8, 0.666 0) μg/L, P=0.001〕. Multivariate Logistic regression analysis showed that serum CTRP3 ratio was an independently associated with GDM〔aOR=0.101, 95%CI (0.010, 0.997) , P≤0.05〕. The AUC of serum CTRP3 ratio in predicting GDM was 0.622〔95%CI (0.571, 0.672) 〕with 49.38% sensitivity, and 72.13% specificity when≤0.524 2 μg/L was chosen as the optimal cutoff value. The AUC of a combined prediction model (serum CTRP3 ratio in combination with age, pre-pregnancy BMI, FPG and HbA1c) in predicting GDM was 0.841〔95%CI (0.799, 0.877) 〕, with 69.14% sensitivity and 89.20% specificity when 0.315 0 was chosen as the optimal cutoff value. The AUC of the combined prediction model was greater than that of serum CTRP3 ratio (Z=5.634, P<0.001) . Conclusion Increased serum CTRP3 ratio may be associated with lowered risk of GDM, so it could be used as an independent predictor for GDM in early pregnancy. Furthermore, its combined use with maternal demographic and metabolic indicators may produce a better predictive value for GDM in early pregnancy.

Keywords

• diabetes, gestational|ctrp3|body mass index|glucose tolerance test