The Relationship Between Gestational Diabetes Mellitus And BMI Before Pregnancy,serum Levels Of VAP-1 And PTX3 During Pregnancy

Purpose:The relationship between Body mass index(BMI),serum levels of Vascular adhesion protein-1(VAP-1),Pentraxin-3(PTX3)and blood glucose in Gestational Diabetes Mellitus(GDM)patients was analyzed,the relationship between BMI,VAP-1,PTX3 and GDM and adverse pregnancy outcomes was evaluated by follow-up analysis.Method:Patients with GDM admitted between January 2020 and December 2021were grouped according to their pre-pregnancy BMI.After the inclusion and exclusion criteria,a total of 206 samples were included in this study.Because the number of patients who met the criteria of weight loss and obesity was too small,in order to ensure the accuracy of the study data,in this study,we excluded the cases of weight loss and obesity,and 200 cases remained.Patients with a BMI of 18.5-23.9 kg/m~2were selected as Group A(n=121),patients with a BMI in the range of 24-27.9 kg/m~2 were in Group B(n=79),with a total of 200 patients aged 23-48 years and a mean age of(32.19±4.12)years.Serum Glycated hemoglobin(Hb A1c),Fasting serum insulin,(FINS),VAP-1 and PTX3levels were measured in all patients at 24-28 weeks of gestation.All the patients were followed up and the data of height,parity,age,weight before delivery and weight at the end of pregnancy were collected,complications of pregnancy(postpartum hemorrhage,premature rupture of membranes,puerperal infection,etc.)and adverse outcomes of offspring(premature,low birth weight,macrosomia,fetal distress,etc.)were recorded.All the data were processed by SPSS 22.0 to analyze the adverse pregnancy outcomes and the expression levels of VAP-1 and PTX3 in patients with different pre-pregnancy BMI,and to analyze the correlation between VAP-1,PTX3 and blood glucose,the predictive value of VAP-1,PTX3 and VAP-1 combined with PTX3 in adverse pregnancy outcomes of GDM was analyzed by ROC curve.Result:1.There were 121 cases in group A and 79 cases in group B according to BMI before pregnancy.There was no significant difference in age,pregnancy times,parity,blood pressure,weight gain during pregnancy and weight gain between the two groups,the data were not statistically significant(P<0.05).2.Among the enrolled patients,there were 44 cases of premature rupture of membranes,97 cases of cesarean section,3 cases of postpartum hemorrhage,and 20 cases of postpartum infection.There were 21 macrosomia infants,3 full-term infants with low body weight,and 12 premature infants.3.There was no significant difference in the incidence of premature rupture of membranes,postpartum hemorrhage and postpartum infection between group A and group B,with no statistical significance(P>0.05).The rate of cesarean section in group A was 38.02%,the rate of cesarean section in group B was 64.56%,and the Chi-square value was 13.479.The rate of cesarean section in group B was significantly higher than that in group A,the difference was statistically significant(P<0.05).4.There were no significant differences between group A and group B in the incidence of full-term low birth weight infants,premature infants and neonatal apgar score(P>0.05).The adverse outcome of macrosomia in the offspring of group A was7.44%,group B was 16.46%,and the Chi-square value was 3.970.The incidence of macrosomia in group B was significantly higher than that in group A,and the difference was statistically significant(P<0.05).The blood glucose level of neonates in group A was 3.29 mmol/L±0.53 mmol/L.The blood glucose of neonates in group B was2.96mmol/L±0.72mmol/L,and the t value was 3.728.The blood glucose of neonates in group A was higher than that in group B,and the difference was statistically significant(P<0.05).5.The levels of Hb A1c,FPG,2h PG and FINS in group A were 6.83%±0.23%,6.12mmol/L±2.23 mmol/L,9.21mmol/L±1.56mmol/L,14.87 m U/L±2.12 m U/L,respectively.In group B,Hb A1c,FPG,2h PG and FINS levels were 7.84%±0.31%,7.42mmol/L±1.89 mmol/L,11.08mmol/L±2.01mmol/L,16.90 m U/L±2.06 m U/L,respectively.Corresponding t values were 6.407,4.274,7.387 and 6.694,respectively.Hb A1c,FPG,2h PG and FINS levels in group B were significantly higher than those in group A,and the difference was statistically significant(P<0.001).6.The levels of VAP-1 and PTX3 in group A were 76.45 ng/ml±11.25 ng/ml and6.05 ng/ml±1.43 ng/ml,respectively.The levels of VAP-1 and PTX3 in group B were121.23ng/ml±13.54ng/ml and 9.14ng/ml±1.23ng/ml,respectively.The corresponding t values were 25.368 and 16.277,respectively.The levels of VAP-1 and PTX3 in group B were significantly higher than those in group A,and the difference was statistically significant(P<0.001).7.Serum VAP-1 and PTX3 levels were positively correlated with pre-pregnancy BMI,and the difference was statistically significant(P<0.05).Serum VAP-1 levels were positively correlated with Hb A1c,FPG,2h PG and FINS levels(r=0.532,0.512,0.342,0.318,P<0.05).Serum PTX3 levels were positively correlated with Hb A1c,FPG,2h PG and FINS levels(r=0.632,0.632,0.432,0.348,P<0.05),and the difference asstatistically significant.8.The area under the curve(AUC)of VAP-1 was 0.838(95%CI:0.712-0.963),the truncation value was 45.65ng/ml,the sensitivity was 83.75%,and the specificity was82.14%.The AUC of PTX3 in the prediction of adverse pregnancy outcomes was 0.851(95%CI:0.734-0.969),the truncation value was 4.53mg/ml,the sensitivity was 85.13%,and the specificity was 80.43%.The AUC of VAP-1 combined with PTX3 was 0.884,the sensitivity was 89.34%,and the specificity was 84.22%.VAP-1,PTX3 and VAP-1combined with PTX3 have good predictive value in predicting adverse pregnancy outcomes in patients with gestational diabetes mellitus.Conclusion:High prepregnancy BMI in gestational diabetes patients can increase the occurrence of adverse pregnancy outcomes.Serum VAP-1 and PTX3 in the second trimester are positively correlated with prepregnancy BMI and blood glucose indexes in GDM patients.VAP-1 combined with PTX3 has certain predictive value for adverse pregnancy outcomes in GDM patients.