Low-Grade Inflammation in Gestational Diabetes Mellitus and Its Correlation with Maternal Insulin Resistance and Fetal Growth Indices

Abstract

Kien Xuan Nguyen,1,* Tien Bui Minh,2,* Hoa Trung Dinh,3,4 Tien Viet Tran,5 Tuan Dinh Le,5,* Nga Phi Thi Nguyen,6 Thi Thanh Hoa Tran,3 Trinh Hien Vu,3 Lan Ho Thi Nguyen,3 Kien Trung Nguyen,2 Nguyen Huy Thong,6 Khanh Do,6 Trung Kien Nguyen,7 Hung Nguyen Dao,8 Son Tien Nguyen6,* 1Department of Military Medical Command and Organization, Vietnam Medical Military University, Ha Noi, Vietnam; 2Department of Obstetrics and Gynecology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam; 3Department of Requested Treatment, National Hospital of Endocrinology, Ha Noi, Vietnam; 4National Hospital of Endocrinology, Ha Noi, Vietnam; 5Department of Infectious Diseases, Military Hospital 103, Vietnam Medical Military University, Hanoi, Vietnam; 6Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam; 7Hematology and Blood Transfusion Center, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam; 8Department of Obstetrics and Gynecology, Military Hospital 103, Vietnam Military Medical University, Ha Noi, Vietnam*These authors contributed equally to this workCorrespondence: Son Tien Nguyen, Department of Rheumatology and Endocrinology, Military Hospital 103, Vietnam Military Medical University, 160 Phung Hung Street, Phuc La Ward, Ha Dong District, Hanoi City, Vietnam, Email [email protected]: Chronic low-grade inflammation (LGI) plays a role in the pathogenesis of gestational diabetes mellitus (GDM). LGI, on the one hand, promotes insulin resistance and at the same time, affects fetal development. The study aimed to use clinically feasible means to evaluate the association between maternal LGI and maternal insulin resistance and fetal growth indices by ultrasound in the third trimester.Methods: A crossectional and descriptive study on 248 first-time diagnosed GDM in Vietnam.Results: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) indices were significantly higher in GDM than in normal glucose-tolerant pregnancies (p = 0.048 and 0.016, respectively). GDM with LGI witnessed significantly higher systolic blood pressure, BMI, HbA1c, and significantly lower quantitative Insulin Sensitivity Check Index (QUICKI) than those without LGI. After adjusting for maternal BMI, fasting plasma glucose (FPG), age, and parity, C-reactive protein (CRP) was positively correlated with HOMA2-IR (B=0.13, p< 0.01) and Mathews index (B=0.29, p< 0.01). Regarding fetal characteristics, LGI was associated with fetal growth indices in the third trimester of GDM. NLR was negatively correlated with estimated fetal weight (EFW) (B=− 64.4, p< 0.05) after adjusting for maternal BMI and FPG. After adjusting for maternal BMI, FPG, age, and parity, PLR was negatively correlated with biparietal diameter (B=− 0.02, p< 0.01) and abdominal circumference (AC) (B=− 0.16, p< 0.05), and EFW (B=− 1.1, p< 0.01), and head circumference (HC) (B=− 0.06, p< 0.01); CRP was negatively correlated with AC (B=− 0.16, p< 0.001), EFW (B=− 85.3, p< 0.001), and HC (B=− 5.0, p< 0.001).Conclusion: In the third trimester, LGI was associated with maternal glucose and insulin resistance in GDM. Moreover, LGI was associated with fetal characteristics in ultrasonic images. There were negative correlations between LGI and fetal developmental characteristics.Keywords: gestational diabetes mellitus, low-grade inflammation, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, fetal ultrasound parameters

Keywords

• gestational diabetes mellitus
• low-grade inflammation
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio
• fetal ultrasound parameters.