Early second trimester maternal serum markers in the prediction of gestational diabetes mellitus

Aims/introduction: To determine whether maternal serum markers in the early second trimester are useful for prediction of gestational diabetes mellitus (GDM).

Materials and methods: A total of 876 singleton pregnancies were recruited in the present study. Blood samples were collected during 16-20 gestational weeks. GDM women were diagnosed by an oral glucose tolerance test during 24-28 gestational weeks. A total of 56 women with GDM and 73 healthy pregnant women were selected. Maternal serum concentrations of placental protein 13 (PP13), pentraxin 3 (PTX3), soluble fms-like tyrosine kinase-1 (sFlt-1), myostatin and follistatin (FST) were detected at 16-20 weeks' gestation. All of these markers concentrations were expressed as multiples of the medians. The Mann-Whitney U-test was used for comparison of the multiples of the medians of different concentrations of these five serum markers between the GDM group and the control group. Receiver operating characteristic curve analysis was applied to assess the sensitivity and specificity of significant serum markers from a Mann-Whitney U-test comparison.

Results: Compared with healthy pregnancies, the serum levels of PP13, PTX3, sFlt-1, myostatin and FST in the early second trimester were significantly increased in patients who had developed GDM late. In screening for GDM by PP13, PTX3, sFlt-1, myostatin and FST, the detection rates were 92.3, 94.9, 94.9, 92.5 and 92.3%, respectively at 80% specificity. PTX3 and sFlt-1 were the most sensitive markers.

Conclusions: Maternal serum markers including PP13, PTX3, sFlt-1, myostatin and FST increase in the early second trimester of women with GDM. These five markers, especially PTX3 and sFlt-1, could have the value of prediction for those patients who would develop GDM in the late second trimester.