Predictive Value Of Percentage Of Body Fat And Plood Lipid Level In Early Pregnancy On Gestational Diabetes Mellitus

Background and ObjectiveGestational diabetes mellitus（GDM）is a serious complication of obstetrics,which has a serious impact on the mother and fetus.Therefore,the necessity of routine gestational diabetes screening for pregnant women in the first trimester and the necessity of identifying risk groups from the early stage are useful tools for better management of gestational diabetes.GDM lacks specific clinical symptoms,signs and predictive indicators in early pregnancy,and clinical diagnosis is often only in the middle and late stages of pregnancy.Therefore,the prediction research of GDM in early pregnancy has always been an important research hotspot in the perinatal field.At present,the influence of the characteristics of human body fat distribution on disease risk has become a hot topic in recent years.Therefore,the body fat percentage,which reflects the ratio of human body fat to non-fat tissue,and the visceral fat index,which reflects the visceral fat tissue,are gradually being recognized by researchers.This study tried to explore the relationship between pregnant women’s body fat rate,visceral fat index,blood lipid level and other indicators in early pregnancy and GDM,so as to screen out appropriate predictors,and provide clinicians with early prediction of the occurrence of GDM and implementation of interventions to reduce the occurrence of GDM Rate provides a basis.Materials and Methods1.MaterialsCollected all primiparous women who were filed in the outpatient clinic of our hospital from January 2019 to December 2020 during the first trimester and met the inclusion criteria.Use the electronic medical record system of our hospital to collect basic clinical data such as age,gestational week,pregnancy and parity,Body Mass Index（BMI）and other basic clinical data of all pregnant women at the time of card establishment at 11¹3 weeks of pregnancy,as well as percentage of body fat（PBF）,visceral adiposity index（VAI）,total cholesterol（TC）,triglycerides（TG）,high density lipoprotein（HDL）and low density lipoprotein（LDL）,which may affect the occurrence of GDM.The risk factors of the patients were followed up to 24²8 weeks of gestation to observe the screening results of GDM.The diagnostic criteria of GDM refer to the "Guidelines for Diagnosis and Treatment of Diabetes Mellitus in Pregnancy" issued by the Obstetrics and Gynecology Branch of the Chinese Medical Association in 2014.According to the results of OGTT results,the subjects were divided into Case group and Control group.The differences of BMI,PBF,VAI and various blood lipid levels in early pregnancy were compared between the two groups of pregnant women.According to the BMI classification criteria proposed in the "Guidelines for the Prevention and Control of Overweight and Obesity in Chinese Adults",the BMI levels of the study subjects in the early pregnancy were divided into underweight groups（<18.5kg/m²）and normal weight groups（18.5²4.9kg/m²）,overweight group（25²7.9kg/m²）and obesity group（>28kg/m²）,a total of four groups.By comparing the BF,VAI,and blood lipid levels of pregnant women in the case group and the control group in different BMI levels,in order to more accurately explore the effective indicators that can predict GDM under different BMI levels.2.MethodsSPSS22.0 through statistical software for statistical processing and data analysis.Firstly,Kolmogorov-Sminov（K-S）test is used to test whether the data are normally distributed,and the normal distribution were expressed as mean ± standard deviation（（?）±s）,two groups of mean comparing with two independent samples t test,Comparison of three groups and above materials adopts analysis of variance,the measurement data of non-normal distribution is expressed as the median（M）[quartileP₂₅^P₂₅],and the comparison between the two groups uses two independent samples nonparametric test（Mann-Whitney U）,Kruskal-Wallis H test was used for more than three groups.Count data is expressed by frequency or rate（%）,and X² test is used for comparison between groups.The relationship between blood lipid level,body fat rate,and visceral fat index was analyzed by Pearson correlation analysis.GDM risk factors adopt multivariate logistics regression analysis to analyze the relationship between various indicators and GDM,calculate the area under the curve（AUC）through receiver operating characteristic（ROC）,and calculate the best cut-off value of each risk factor according to Youden index.And calculate the Sensitivity and the Specificity at the best cut-off value.p<0.05 indicates that the difference is statistically significant.Results1.A total of 805 primiparous women were investigated this time.After collating the data,the final effective sample size was 716,and the data validity rate was 88.9%.According to the GDM diagnostic criteria,154 cases were diagnosed as GDM（21.5%）.There was no significant difference in the basic clinical data（age,gestational age）between the two groups of pregnant women（p>0,05）;The levels of PBF,VAI,TC and TG were significantly higher than those of the control group,and the difference was statistically significant（p<0.001）;the HDL levels of pregnant women in the early pregnancy of the case group were significantly lower than those of the control group,and the difference was statistically significant（p<0.001）).2.The BMI（OR =0.764,95%Cl: 0.677⁰.863）,PBF（OR =1.315,95%Cl:1.146¹.510）,VAI（OR =0.210,95%Cl:1.872⁴.270）and TG（OR =7.252,95%Cl:4.513¹1.653）of pregnant women in the first trimester are GDM is an independent risk factor for pregnant women,and HDL in early pregnancy is a protective factor for pregnant women with GDM.3.The area under the PBF,VAI and TG predicted GDM risk curve of pregnant women in the first trimester are 0.849,0.861,and 0.806,respectively.The best threshold points are 28.15%,6.5,and 1.71 mmol/L,and the sensitivity is 89.6% and 79.2%.,80.5%,the specificity is 70.5%,83.8%,71.5%.4.The PBF of pregnant women in early pregnancy was positively correlated with serum TG（r=0.265,p<0.001）,and was negatively correlated with serum HDL levels（r=-0.120,p =0.001）;VAI of pregnant women in early pregnancy was correlated with serum levels TG level was positively correlated（r=0.303,p<0.001）,and negatively correlated with serum HDL level（r=-0.094,p =0.012）.5.The incidence of GDM is different in different BMI categories in early pregnancy.With the increase of BMI level,the incidence of GDM increases correspondingly,and the difference is statistically significant（p <0.005）.6.In pregnant women with normal BMI,the area under the curve of PBF,VAI and TG predicting the risk of GDM were 0.941,0.929,and 0.860,respectively.The best threshold points were 28.35%,5.5,and 1.56 mmol/L,and the sensitivity was 90.0% 100.0%,90.0%,specificity is 94.6%,68.8%,70.7%;in pregnant women with BMI hyperrecombination,the area under the curve of PBF,VAI and TG predicting the risk of GDM were 0.829,0.843,and 0.775,respectively,and the optimal threshold points were 28.5%,6.5,and 1.76 mmol/L,and their sensitivities were 91.7% and 86.9%.,90.0%,specificity is 59.0%,72.0%,70.7%;in pregnant women with BMI obese group,the area under the curve of PBF,VAI and TG predicting the risk of GDM were 0.867,0.887,and 0.801,respectively.The best threshold points were 31.65%,6.5,and 2.18 mmol/L,and the sensitivity was 75.0%,84.1%,75.0%,the specificity was 87.7%,81.6%,75.4%.7.The area under the curve of PBF,VAI and TG of pregnant women with normal BMI in early pregnancy calculated by ROC curve are 0.941,0.929 and 0.860 respectively,so the body fat percentage,visceral fat index and triglycerides are also Can effectively predict the occurrence of GDM in low-risk pregnant women.Conclusion1.The BMI,PBF,VAI and TG of pregnant women in early pregnancy are independent risk factors for the occurrence of GDM in pregnant women,and HDL in early pregnancy is a protective factor for pregnant women.2.THE PBF,VAI and TG of pregnant women in early pregnancy can be used as independent predictors of GDM,and its diagnostic performance is better than BMI.3.Regardless of whether the weight of the pregnant woman is normal,overweight or obese,the PBF,VAI and TG levels of pregnant women in the first trimester can be used as independent predictors of GDM.Especially in pregnant women with normal weight,these three indicators have a higher level of GDM.Predictive value.4.Clinically,we can use body composition analysis and blood lipid levels as routine examination items in the early pregnancy of pregnant women to provide guidance for clinical doctors in predicting the occurrence of GDM.If abnormalities are found,early intervention is needed to adjust the pregnant women’s diet patterns and exercise appropriately.To reduce the incidence of gestational diabetes.