The Study On The Association Between Serum Adrenomedullin Levels And Gestational Diabetes Mellitus Risk During The Pregnancy

Objective: To explore the relationship between serum adrenomedullin(ADM)level and the risk of gestational diabetes mellitus(GDM),and to provide a new horizon for clinical prevention and treatment of GDM.Methods: We conducted a nested case–control study based on the Tongji-Central Hospital Maternal and Child Health Cohort.GDM cases and controls were identified and matched for age,body mass index(BMI)before pregnancy,gestational weeks of blood collection and parity.Serum insulin level was determined by automatic electrochemical luminescence,Mid-regional pro-adrenomedullin(MR-proADM)level was detected by double-antibody sandwich enzyme-linked immunosorbent assay,and serum fasting blood-glucose(FBG),total cholesterol(TC),triglyceride(TG)levels of pregnant women were determined by enzymatic method.Pearson and Spearman correlation coefficients were used to analyze the correlation between ADM and baseline indexes.The association between ADM and GDM risk was analyzed by conditional Logistic regression model.Results: In this study,total 116 pregnant women with GDM(n=58)and normal glucose tolerance(n=58)were finally enrolled according to the inclusion and exclusion criteria,including 44 in the first trimester and 72 in the second trimester.The results showed that serum MR-proADM level was significantly higher in the second trimester than that in the first trimester(P < 0.001),and MR-proADM level of pregnant women with GDM in the first trimester was significantly higher than that in control pregnant women(P = 0.033).However,there was no significant difference of MR-proADM level between GDM cases and controls in the second trimester.Serum MR-proADM level was positively correlated with fasting insulin,insulin resistance index,TG and systolic blood pressure.In the analysis of conditional logistic regression model,the risk of GDM increased by 97.4%(OR: 1.974,95% CI: 1.141,3.416)for 1 Standard Deviation(SD)increasing in serum MR-proADM after adjusted for gestational weeks of blood collection,family history of diabetes,educational level,secondhand smoke,drinking habits,and FBG and fasting insulin levels.In the first trimester,the adjusted OR value and 95% CI of the GDM risk were 3.487(1.032,11.782)for increase 1 SD of MR-proADM.While in the second trimester,the OR value and 95% CI of the risk of GDM were 1.465(0.700,3.150).Conclusions: Serum MR-proADM level gradually increased during pregnancy.Our findings indicate that serum MR-proADM level in the second trimester was significantly higher than that in the first trimester.In addition,there was a significant positive correlation between ADM and the risk of GDM during pregnancy.Interestingly,it is elevated serum ADM level during the first trimester rather than the second trimester that may increase the GDM risk.