Establishment of gestational diabetes risk prediction model and clinical verification

Risk Factors for Gestational Diabetes Mellitus in Mainland China: A Systematic Review and Meta-Analysis

Objective

This study aimed to identify and evaluate risk factors associated with gestational diabetes mellitus (GDM) in mainland China.

Methods

Eight electronic databases were searched for literature published from January 2010 until December 2023. Heterogeneity was quantified using I2. Data were pooled by fixed or random effects models and expressed as odds ratio and 95% confidence intervals.

Results

A total of 69 observational studies with an overall sample size of 2,138,032 Chinese women and 219,303 patients with GDM were included in the analysis. After adjusting confounders, older maternal age (OR = 1.12, 95% CI: 1.09-1.15), maternal age ≥35 years (OR = 1.96, 95% CI: 1.74-2.21), higher pre-pregnancy body mass index (OR = 1.24, 95% CI: 1.17-1.32), pre-pregnancy overweight (OR = 1.78, 95% CI: 1.64-1.92) or obesity (OR 2.52, 95% CI: 2.06-3.08), family history of diabetes (OR = 1.85, 95% CI: 1.58-2.17), history of GDM (OR = 4.09, 95% CI: 2.13-7.82), and elevated levels of fasting plasma glucose (OR = 2.54, 95% CI: 2.13-3.01), hemoglobin (OR = 1.47, 95% CI: 1.14-1.89) and serum triglycerides (OR = 1.69, 95% CI: 1.31-2.16) in early pregnancy were associated with an increased risk of GDM in mainland China. But gravidity ≥2 (OR = 1.06, 95% CI: 0.89-1.27), conception by assisted reproductive technology analyses (OR = 1.54, 95% CI: 0.95-2.51) were not associated with GDM, and parity ≥1 (OR = 0.88, 95% CI: 0.82-0.94) was related to lower risk of GDM. In available unadjusted studies, history of abortion (OR = 1.34, 95% CI: 1.31-1.37) increased risk of GDM, non-Han ethnicity (OR = 0.78, 95% CI: 0.59-1.03) and high school or lower education level (OR1.09, 95% CI: 0.94-1.26) showed no correlation with GDM.

Conclusion

The key risk factors for GDM in mainland China included older maternal age, maternal age ≥35 years, pre-pregnancy overweight or obesity, family history of diabetes, history of GDM, elevated levels of FPG, Hb, and serum TG in early pregnancy. Early identification and intervention for women at high risk should be performed to prevent the development of GDM.

Association and function analysis of genetic variants and the risk of gestational diabetes mellitus in a southern Chinese population

Background

Gestational diabetes mellitus (GDM) is a complex metabolic disease that has short-term and long-term adverse effects on mothers and infants. However, the specific pathogenic mechanism has not been elucidated.

Objective

The aim of this study was to confirm the associations between candidate genetic variants (rs4134819, rs720918, rs2034410, rs11109509, and rs12524768) and GDM risk and prediction in a southern Chinese population.

Methods

Candidate variants were genotyped in 538 GDM cases and 626 healthy controls. The odds ratio (OR) and its corresponding 95% confidence interval (CI) were calculated to assess the associations between genotypes and GDM risk. Then, the false-positive report probability (FPRP) analysis was adopted to confirm the significant associations, and bioinformatics tools were used to explore the potential biological function of studied variants. Finally, risk factors of genetic variants and clinical indicators identified by logistics regression were used to construct a nomogram model for GDM prediction.

Results

It was shown that the XAB2 gene rs4134819 was significantly associated with GDM susceptibility (CT vs. CC: adjusted OR = 1.38, 95% CI: 1.01-1.87, p = 0.044; CT/TT vs. CC: crude OR = 1.42, 95% CI: 1.08-1.86, p = 0.013). Functional analysis suggested that rs4134819 can alter the specific transcription factors (CPE bind and GATE-1) binding to the promoter of the XAB2 gene, regulating the transcription of XAB2. The nomogram established with factors such as age, FPG, HbA1c, 1hPG, 2hPG, TG, and rs4134819 showed a good discriminated and calibrated ability with an area under the curve (AUC) = 0.931 and a Hosmer-Lemeshow test p-value > 0.05.

Conclusion

The variant rs4134819 can significantly alter the susceptibility of the Chinese population to GDM possibly by regulating the transcription of functional genes. The nomogram prediction model constructed with genetic variants and clinical factors can help distinguish high-risk GDM individuals.

Functional genetic variants and susceptibility and prediction of gestational diabetes mellitus

The aetiological mechanism of gestational diabetes mellitus (GDM) has still not been fully understood. The aim of this study was to explore the associations between functional genetic variants screened from a genome-wide association study (GWAS) and GDM risk among 554 GDM patients and 641 healthy controls in China. Functional analysis of single nucleotide polymorphisms (SNPs) positively associated with GDM was further performed. Univariate regression and multivariate logistic regression analyses were used to screen clinical risk factors, and a predictive nomogram model was established. After adjusting for age and prepregnancy BMI, rs9283638 was significantly associated with GDM susceptibility (P < 0.05). Moreover, an obvious interaction between rs9283638 and clinical variables was detected (Pinteraction < 0.05). Functional analysis confirmed that rs9283638 can regulate not only target gene transcription factor binding, but it also regulates the mRNA levels of SAMD7 (P < 0.05). The nomogram model constructed with the factors of age, FPG, 1hPG, 2hPG, HbA1c, TG and rs9283638 revealed an area under the ROC curve of 0.920 (95% CI 0.902-0.939). Decision curve analysis (DCA) suggested that the model had greater net clinical benefit. Conclusively, genetic variants can alter women's susceptibility to GDM by affecting the transcription of target genes. The predictive nomogram model constructed based on genetic and clinical variables can effectively distinguish individuals with different GDM risk factors.

New perspective on first-trimester serum uric acid level in predicting the risk of gestational diabetes mellitus

This study aimed to investigate the correlation between serum uric acid (UA) and gestational diabetes mellitus (GDM) during the first trimester and provide a new perspective for the prevention and treatment of GDM. Based on the diagnostic criteria of gestational diabetes of the International Association of Diabetes and Pregnancy Study Groups, 1744 and 4256 patients were enrolled in the GDM and normal glucose tolerance (NGT) groups. Four groups were constituted based on the quartile of first-trimester serum UA (UA) level, and the differences in each indicator between groups were compared. Logistic regression was used to analyze the effects of UA level on GDM risk. The rate of GDM in the UA quartile changed from low to high. Significant differences were also observed in fasting plasma glucose level, 1 h post glucose and 2 h post glucose levels, in all the groups (P < 0.05), which increased with the UA level. UA level were independent risk factors for GDM. The best threshold of GDM predicted by the first-trimester UA level was 226.55 μmol/L. The first-trimester UA level in patients with GDM was relatively higher and was an independent risk factor for GDM.