The Predictive Value Of Routine Blood Parameters Combined With Glucose Metabolism Index In Early Pregnancy For Gestational Diabetes Mellitus

Objective:1 To explore the relationship between routine blood parameters and glucose metabolism indexes and GDM in early pregnancy,and to provide clinical evidence for the study of the etiology and pathogenesis of GDM.2 To construct a prediction model for GDM in early pregnancy,and to evaluate whether blood routine parameters and glucose metabolism indexes can be valuable predictors of GDM and their differences between single and combined use and predictive value.Methods :1 From September 2019 to December 2021,295 pregnant women with confirmed GDM who had their pregnancy terminated by the First Hospital of Hebei North College were selected as the experimental group,and 1204 pregnant women with normal glucose tolerance test(OGTT)results at 24-28 weeks of gestation were randomly selected as the control group.The 306 cases were randomly selected from 1204 pregnant women with normal results of 75 g glucose tolerance test(OGTT)at 24-28 weeks of pregnancy as the control group.2 The pregnant women in the group were enrolled in the first pregnancy checkup at 9-12 weeks of gestation,and their basic conditions were registered: age,height,weight,pregnancy,delivery and family history of type 2 diabetes mellitus(T2DM),and fasting median venous blood was collected for routine blood tests,fasting blood glucose(FPG)and fasting insulin(FINS).Fasting insulin(FINS)and other indicators were measured.3 The correlation between risk factors and GDM was analyzed by multifactor logistic regression analysis.(AUC)to analyze the difference between the single and combined prediction of routine blood and glucose metabolism indexes in early pregnancy,and to examine their clinical predictive value for the development of GDM.Results:1 Comparative results of the general conditions of the two groups: age,gestation,delivery,family history of T2 DM and pre-pregnancy BMI of pregnant women in the GDM group were higher than those in the control group,but the differences were not statistically significant(P >0.05).2 Clinical data of GDM group: white cell count(WBC),red blood cell(RBC),haemoglobin(Hb),hematocrit(HCT),FPG,FINS and HOMAIR of pregnant women in the GDM group were all higher than those of the control group.The comparison between the two groups was not statistically significant(P >0.05),except for the comparison of HCT between the two groups,the other six groups were statistically significant(P <0.05).3 The results of the multi-factor logistic regression analysis were as follows:3.1 Maternal age as an independent risk factor for the development of GDM:Maternal age(aOR =1.071,95% CI=1.012 to 1.134).3.2 WBC,RBC,Hb and FPG in early pregnancy as independent risk factors for GDM.(1)WBC levels in early pregnancy(aOR=1.163,95%CI=1.035~1.307).(2)RBC levels in early pregnancy(aOR=2.265,95% CI=1.844-2.781).(3)Hb levels in early pregnancy(aOR=1.031,95% CI=1.002~1.062).(4)FPG levels in early pregnancy(aOR=4.772,95% CI=2.584~8.812).4 Routine blood parameters WBC,RBC,Hb and FPG levels in early pregnancy were used to construct a GDM prediction model,and single index ROC curves were analyzed as follows:(1)The AUC of WBC in early pregnancy to predict GDM was 0.596,with a sensitivity of 68% and specificity of 49%,and a corresponding to a cut-off value of 8.46×109/L.(2)The AUC of RBC in early pregnancy to predict GDM was 0.617,with a sensitivity of 39%,a specificity of 100%,and a corresponding cut-off value of 5.95×109/L.(3)Hb in early pregnancy predicts GDM with an AUC of 0.635,a sensitivity of 60%,a specificity of 61%,andacorresponding cut-off value of 129 g/L.(4)The AUC of FPG in early pregnancy for predicting GDM was 0.7,with a sensitivity of 57%,and a Jorden index of 0.308,corresponding to a cut-off value of 4.92 mmol/L.(5)The largest AUC of the four WBC,RBC,Hb,and FPG in early pregnancy was 0.7,indicating the low predictive value of a single index for the onset of GDM.5 The ROC curves for the combination of multifactorial indicators with the following predictive values:(1)The AUC of WBC+RBC in early pregnancy was 0.635,with a sensitivity and specificity of 61% and 63%,respectively.(2)The AUC of WBC+RBC+Hb in early pregnancy was 0.733,with sensitivities and specificities of 69% and 64%,respectively.(3)The AUC of WBC+RBC+Hb+FPG in early pregnancy was 0.797,with sensitivities and specificities of 75% and 70%,respectively.(4)The AUC,sensitivity and specificity of WBC+RBC+Hb+FPG in early pregnancy were slightly higher than the rest of the combined models,and the difference was statistically significant(P < 0.05).Conclusion:1 WBC,RBC,Hb,FPG,FINS and HOMA-IR levels were correlated with the onset of GDM in early pregnancy,among which WBC,RBC,Hb and FPG were positively correlated with the onset of GDM.2 The combination of routine blood parameters WBC,RBC,Hb and FPG levels in early pregnancy has a good predictive value for GDM,which is better than single indicators.3 The detection of blood routine combined with FPG can be used to predict GDM in early pregnancy,and this method has the advantages of simplicity,economy and efficiency,and triage of pregnant women according to the results,and early dietary and exercise interventions in high-risk pregnant women,thus reducing the incidence of GDM.