Table 1. Gestational diabetes mellitus predictors and biomarkers.
Pregnancy period | Values in GDM pregnancy | References | |
---|---|---|---|
Conventional predictors | |||
Impaired glucose tolerance | Between weeks 24 and 28 | Assessed by OGTT: fasting > 5.1 mmol/L, 1st hour > 10 mmol/L or 2nd hour > 8.5 mmol/L | 15-17 |
Glycated haemoglobin | NA | > 6.5% (48 mmol/mol) | 24 |
Body mass index | NA | > 30 kg/m2 | 7 |
History of GDM | NA | positive | 7 |
Conventional GDM biomarkers | |||
Fasting plasma glucose | Early pregnancy | > 5 mmol/L, > 4.7 mmol/L or > 4.5 mmol/L | 23,25-27 |
Hormones involved in energy homeostasis | |||
C-peptide | NA | C-peptide | 30,31 |
Fasting insulin | NA | insulin | 30,31 |
Impaired insulin sensitivity | NA | Deviation from normal insulin concentrations assessed by measurement of fasting insulin and OGTT insulin (or 2 h postprandial insulin) | 28 |
Homeostatic Model Assessment of Insulin Resistance | NA | Insufficient as a predictive marker for GDM | 7 |
SHBG | Before and in early pregnancy | Ż SHBG | 5 |
Leptin | During the whole pregnancy (because of placental production) | leptin | 2 |
Adiponectin | In the first and second trimester | Ż adiponectin among women who develop GDM in the third trimester | 2,5 |
Amino acid profile | |||
Branched amino acids | In the first trimester; also valine, leucine and isoleucine in the second and third trimesters | valine, leucine and isoleucine | 36-38 |
Aromatic amino acids | In the third trimester | phenylalanine and tyrosine | 98 |
Sulfur-containing amino acids | NA | methionine, contradictory findings for cystine and homocysteine | 18,40,41 |
Arginine | In the first trimester | arginine | 42 |
Glycine | In the first trimester | Contradictory findings | 42 |
Other amino acids | NA | When asparagine, threonine, aspartate, phenylalanine, glutamine risk of GDM is increased |
43 |
Tryptophan metabolite, serotonin | NA | serotonin | 44,45 |
Fatty acids | |||
Long chain polyunsaturated fatty acids and essential fatty acids | NA | Ż placental uptake | 46 |
FFA | NA | FFA | 47 |
Inflammatory biomarkers | |||
C-reactive protein (CRP) or highly sensitive C-reactive protein (hs-CRP) | NA | CRP, hs-CRP; not specific to pregnancy | 2,5,7 |
Pregnancy period | Values in GDM pregnancy | References | |
Tumour necrosis factor alpha | NA | Contradictory findings | 53,57,58 |
Interleukin-6 | NA | Contradictory findings | 53,57,58 |
Whole blood parameters (not specific for pregnancy) | |||
Blood cell count (erythrocytes, leukocytes, neutrophils, lymphocytes and monocytes) | NA | blood cell count | 12,59 |
MCV and MCH | NA | Ż MCV and MCH | 59 |
Ratio of blood cells (e.g., NLR or MLR) | NA | NLR, MLR | 11,60-62 |
Platelet count | NA | platelet count | 59 |
MPV | NA | Ż MPV | 59 |
Ratio of pro-inflammatory T-helpers (Th1 and Th17) and anti-inflammatory cells (T regulatory cells, Treg, and Th2) | NA | ratio Th1 and Th17 to Treg and Th2 | 63 |
CD3+, CD4+, CD8+ | NA | CD3+, CD4+, CD8+ | 65,66,67 |
Novel GDM biomarkers | |||
BNP | NA | Ż BNP | 5 |
Afamin | First trimester | afamin | 68 |
FGF21 | First trimester | FGF21 | 69 |
ANGPTL8 | Early pregnancy | ANGPTL8 | 70 |
Placental lactogen | NA | placental lactogen | 71 |
Galanin | Second trimester | galanin | 72 |
VAP1 | Second trimester | VAP1 | 73 |
FABP4 | Second trimester | FABP4 | 74 |
Fetuin-A or AHSG | In the first and second trimester | fetuin-A | 78-82 |
pGCD59 | Prior week 20 | pGCD59 | 95 |
Extracellular vesicles | Between weeks 11 and 14 | Characteristic content, further research necessary | 75,77 |
Maternal microbiota | NA | Contradictory findings, better used as monitoring tool | 85-92 |
PIGF | Early pregnancy | PIGF | 96,97 |
GDM - gestational diabetes mellitus. NA - not applicable. OGTT - oral glucose tolerance test. SHBG - sex hormone-binding protein. FFA - free fatty acids. CRP - C-reactive protein. hs-CRP - high sensitive C-reactive protein. MCV - mean corpuscular volume. MCH -mean corpuscular haemoglobin. NLR - neutrophil to lymphocyte ratio. MLR - monocyte to lymphocyte ratio. MPV - mean platelet volume. Th - inflammatory T-helpers. CD - cluster of differentiation. BNP - brain natriuretic peptide. FGF21 - fibroblast growth factor 21. ANGPTL8 - angiopoietin-like protein 8. VAP1 - vascular adhesion protein 1. FABP4 - fatty acid-binding protein 4. AHSG - α2-Heremans-Schmid glycoprotein. pGCD59 - plasma glycated CD59. PIGF - placenta growth factor. |