Study On The Relationship Between Metabolism Index,Serum CTRP3 Level And GDM In Early Pregnant Women And Their Predictive Value

Background:Gestational diabetes mellitus(GDM)is characterized by impaired ?-cell function and insulin resistance.In recent years,the incidence rate of GDM has been rising.GDM increases the risk of adverse outcomes in pregnant women,fetuses and even postpartum newborns.At present,75 g oral glucose tolerance test is performed in 24-28 weeks of pregnancy to screen GDM,but the examination process is too complicated,and the treatment after diagnosis of GDM can not improve the long-term adverse outcome.Therefore,it is very important to predict GDM and take preventive measures in early pregnancy.During pregnancy,the energy of the fetus mainly comes from the mother.Estrogen and progesterone promote the mother to increase the use of glucose,so as to meet the needs of the fetus.Placental synthesis of estrogen,progesterone and so on has the function of antagonizing insulin,making insulin resistance in the body,hyperfunction of islet ? cells,increasing insulin secretion to maintain the balance of glucose metabolism in the body.When the function of ? cell is damaged,GDM will occur.At present,obesity and old age are independent risk factors of GDM,and glycolipid metabolism indexes in early pregnancy play a certain role in the occurrence of GDM,but the existing research conclusions are still inconsistent,and there are few prospective studies.The occurrence of GDM is not only related to insulin resistance caused by the change of hormone level during pregnancy,but also related to genetic factors,fat factors and inflammatory factors.Adiponectin(APN),one of the most familiar adipokines,is closely related to insulin resistance and plays an important role in the pathogenesis of GDM.Complement-c1 q / tumor necrosis factor related proteins(CTRPs)are a super family of fat factors with 15 members(CTRP1-15),which are homologous with APN.CTRP3 has many functions,such as anti-inflammatory,regulating endocrine and glycolipid metabolism.Therefore,it is speculated that it has similar biological function with APN or synergism with APN and participates in the occurrence and development of GDM.A study of 24-28 week pregnant women found that the serum CTRP3 level in GDM group was lower than that in normal glucose tolerance(NGT)group,which was positively correlated with ? cell function of islets of Langerhans and negatively correlated with insulin resistance,suggesting that serum CTRP3 participated in the development of GDM.But what is the level of CTRP3 in maternal fasting serum in early pregnancy? Is it related to insulin resistance and GDM? Can it be used as an indicator to predict GDM? There is no report at home and abroad.Objective:1 To explore the relationship between maternal glycolipid metabolism index and serum CTRP3 and GDM in early pregnancy,so as to provide clinical evidence for the etiology and pathogenesis of GDM.2 To build GDM early pregnancy prediction model,enrich the theoretical research results of GDM early prediction,evaluate whether CTRP3 can be a valuable GDM prediction factor,and provide new ideas for further improving GDM early prediction model.Methods:Using prospective cohort study method,qualified pregnant women with gestational age of 6-14 weeks were included in the cohort in the obstetric clinic.The demographic characteristics,last menstrual time,pregnancy and childbirth history,family history and weight of the first month before pregnancy were collected through questionnaire survey.The blood pressure,height and weight of pregnant women were measured,and the empty space of pregnant women was collected The fasting plasma glucose(FPG),glycosylated hemoglobin(Hb A1c),blood lipid and fasting insulin(FINS)were measured,and other indicators,enzyme-linked immunosorbent assay was used to detect the level of serum CTRP3.At 24-28 weeks of gestation,75 g oral glucose tolerance test was used for GDM screening,and medical records were consulted to obtain pregnancy outcome,including delivery mode,birth weight of newborn and other information.SPSS19.0 software was used to analyze the data.M(P25-P75),composition ratio,rate and other indexes were used to describe the data.Wilcoxon rank sum test and ? 2 test were used to compare the two independent samples.The correlation coefficient was calculated by Spearman correlation analysis.Multivariate logistic regression was applied to analyze the relationship between maternal characteristics,glycolipid metabolism indexes,serum CTRP3 level and GDM,and to establish the GDM prediction.The area under the curve(AUC)and 95% confidence interval of CTRP3 and its prediction models were calculated by Med Calc19.0.7 software,and the prediction value was evaluated.The AUC was compared by De-long test.Results:1 A total of 393 women were enrolled in the first trimester.376 cases were followed up.368 cases were included in the analysis.81 of them were diagnosed as GDM and the incidence rate of GDM was 22.01%.2 Compared with the NGT group,the age,gestational age,body mass index(BMI),family history of diabetes,systolic blood pressure,diastolic blood pressure,BMI,FPG,FINS,Hb A1 c,triglycerides(TG),apolipoprotein B(APO-B),homeostasis model assessment of IR(HOMA-IR),homeostasis model assessment of pancreatic beta cell function index in GDM group are higher than those of NGT group(P < 0.05),there was no significant difference in TC,HDL-C,LDL-C,APO-A1(P > 0.05).The CTRP3 level of pregnant women in group GDM was [0.5280(0.4613 to 0.6340)ng/ml] lower than that in group NGT [0.6048(0.5108 ? 0.6660)ng/ml](P < 0.05),and incidence rate of GDM decreased with CTRP3 level increasing,Q1,Q2,Q3,and Q1 groups were 33.7%,22.3%,17.4% and 15.1% respectively(P < 0.05).Single factor Logistic regression analysis showed that CTRP3 was negatively correlated with GDM [OR = 0.031,(95% CI: 0.005-0.210)].CTRP3 was negatively correlated with age,BMI,FPG,FINS,HOMA-IR,TG and APO-A1(P < 0.05).3 Multivariate logistic regression analysis displayed that age(a OR = 1.160,95% CI: 1.088-1.238)and pre pregnancy BMI(a OR = 1.302,95% CI: 1.201-1.413)were independent predictors of GDM,while metabolism index was independent variable(MI model),FPG(a OR = 6.865,95% CI: 2.871-16.413),Hb A1c(a OR = 1.816,95% CI: 1.065-3.096),TG(a OR =,1.611,95% CI: 1.164-2.232)and FINS(a OR = 1.082,95% CI: 1.027-1.139)were independent predictors of GDM.Maternal characteristics and metabolic indicators were independent variables(referred to as MC + MI model),age(a OR = 1.151,95% CI: 1.074-1.233),pre pregnancy BMI(a OR = 1.262,95% CI: 1.157-1.377),Hb A1c(a OR = 1.946,95% CI: 1.120-3.378),FPG(a OR = 4.895,95% CI: 1.963-12.209)were independent predictors of GDM.On the basis of MC + MI model,age(a OR = 1.145,95% CI: 1.068-1.227),pre pregnancy BMI(a OR = 1.296,95% CI: 1.195-1.406),Hb A1c(a OR = 2.039,95% CI: 1.176-3.534),FPG(a OR = 4.548,95% CI: 1.815-11.396)and CTRP3(a OR = 0.101,95% CI: 0.010-0.997)were independent predictors of GDM.4 The AUC of maternal serum CTRP3 was 0.622(95% CI: 0.571-0.672),the sensitivity was 49.38%,and the specificity was 72.13%.AUC of the four models was higher than that of the serum CTRP3(P < 0.05).The AUC of MI model was 0.772(95% CI: 0.726-0.814)and MC model(AUC = 0.812,95% CI: 0.768-0.850),but it was lower than MC + MI model(AUC = 0.834,95% CI: 0.792-0.870)and MC + MI + CTRP3 model(AUC = 0.841,95% CI: 0.799-0.877)(P < 0.05).The AUC,sensitivity and specificity of MC + MI + CTRP3 model were slightly higher than those of MC + MI model,but the difference between them was not statistically significant(P > 0.05).Conclusion:1 Maternal characteristics and metabolic indexes may affect the occurrence of GDM,and maternal characteristics and metabolic indexes have similar predictive value for GDM.2 CTRP3 may be involved in the occurrence of GDM by influencing insulin resistance in the early pregnancy,and CTRP3 is an independent predictor of GDM.