Elevated First-trimester MST1 Was Associated With The Risks Of Gestational Diabetes Mellitus And Adverse Pregnancy Outcomes

Objective Gestational diabetes mellitus(GDM)is a common complication of pregnancy,its incidence is increasing year by year,and causes great harm to mother and child,leading to adverse pregnancy outcome.Due to the late diagnosis of GDM,timely intervention and treatment cannot be performed.Therefore,it is particularly important to explore early prediction methods of GDM.The purpose of this study was to investigate the relationship between maternal serum mammalian sterile 20-like kinase 1(MST1)in early pregnancy and the risk of GDM and adverse pregnancy outcome,in order to find a method to predict GDM early and reduce the occurrence of adverse pregnancy outcome.MethodsA total of 231 women in the first trimester of pregnancy(8-12 weeks)underwent antenatal examination in the obstetric clinic of Tai zhou People’s Hospital from October2019 to March 2021 were prospectively collected.According to whether MST1 was greater than the median 6.77 pg/m L,231 pregnant women were divided into high MST1group(116)and low MST1 group(115).General data including age,height,pre-pregnancy weight,pregnancy duration,family history of diabetes,history of GDM,smoking and alcohol consumption were collected,and pre-pregnancy body mass index(BMI)was calculated.The subjects were followed up to 24-28 weeks of pregnancy,and the 75 g oral glucose tolerance test(75g OGTT)was conducted.Fasting blood glucose(FPG),1-hour postprandial blood glucose(1h PG),2-hour postprandial blood glucose(2h PG)and fasting insulin(FIns)were monitored and compared between the two groups.Homeostatic model assessment of insulin resistance(HOMA-IR)and homeostasis model assessment of β cell function(HOMA-β)were calculated.All subjects were followed up until delivery to collect their pregnancy outcomes.Spearman linear correlation was used to analyze the correlation between MST1 and glucose metabolism indexes.The relationship between serum MST1 and GDM and adverse pregnancy outcome was analyzed by Logistic regression.Results1.The participants were divided into low MST1 group(below 6.77 pg/m L)and high MST1 group(equal or above 6.77 pg/m L)based on the median of MST1 level in first trimester.Compared with low MST1 group,the high MST1 group had higher FPG,2h PG and HOMA-IR;but had lower HOMA-β.Likewise,the high MST1 group had increased incidence of GDM,composite adverse pregnancy outcomes,preterm birth and macrosomia.2.MST1 in first trimester was positively correlated with FPG,HOMA-IR,1h PG,2h PG levels in second trimester,with the co-efficient r values 0.393,0.217,0.130 and 0.143,respectively(P<0.05).On the contrary,MST1 in first trimester was inversely correlated with HOMA-β in second trimester(r =-0.233;P=0.000).3.Logistic regression analysis showed that MST1 was a risk factor for GDM[OR(95%CI):1.357(1.097-1.677),P=0.005].After adjusting for age,pre-pregnancy BMI,family history of diabetes,smoking history,drinking history,history of GDM and pregnancy number,MST1 in early pregnancy was still a risk factor for GDM[a OR(95%CI): 1.341(1.075-1.672),P=0.009].The risk of GDM in pregnant women with MST1≥6.77 pg/m L was approximately 2.3 times that of pregnant women with MST1<6.77 pg /m L [OR(95%CI): 2.295(1.137-4.633),P=0.020].After adjusting for the above factors,the results were still statistically significant[a OR(95%CI): 2.276(1.084-4.870),P=0.030].4.Logistic regression analysis showed that adjusting for age,pre-pregnancy BMI,family history of diabetes,smoking history,drinking history,GDM history and pregnancy number,MST1 was still a complex adverse pregnancy outcome [a OR(95%CI):1.375(1.124-1.682),P=0.002],preterm birth[a OR(95%CI): 1.512 (1.087-2.104),P=0.014] and macrosomia[a OR(95%CI):1.413(1.029-1.940),P=0.032].The risk of complex adverse pregnancy outcome in pregnant women with MST1≥6.77 pg/m L was approximately 2.9 times that of pregnant women with MST1<6.77 pg /m L[a OR(95%CI):2.865(1.479-5.553),P=0.002].The risk of preterm birth was about 3.7 times [a OR(95%CI):3.676(1.136-11.898),P=0.030],and the risk of macrosomia was about 5.3 times [a OR(95%CI):5.340(1.464-19.483),P=0.011].ConclusionSerum MST1 level in GDM patients in early pregnancy was positively correlated with FPG,1h PG,2h PG and HOMA-IR,and negatively correlated with HOMA-β.MST1 could increase the risks of GDM and adverse pregnancy outcomes(especially premature delivery and macrosomia),suggesting that MST1 may be involved in the occurrence and development of GDM and adverse pregnancy outcomes.It provides a new way to predict GDM early and reduce adverse outcome.