Relationship between inflammatory markers, glycated hemoglobin and placental weight on fetal outcomes in women with gestational diabetes

ABSTRACT Objective: The aim of this study was to evaluate the relationship between inflammatory cytokines, placental weight, glycated hemoglobin and adverse perinatal outcomes (APOs) in women with gestational diabetes mellitus (GDM). Subjects and methods: This was a prospective, longitudinal and observational study conducted from April 2004 to November 2005 in Bauru, Brazil. Included patients had singleton pregnancies and performed a 100 g OGTT and had the levels of C-reactive protein (CRP), interleukin (IL)-6, TNF alfa and glycated hemoglobin (HbA1c) determined at 24-28th gestation weeks. Results: A total of 176 patients were included, of whom 78 had the diagnosis of GDM (44.3%). Multivariate analysis demonstrated that HbA1c, age, body mass index (BMI) and previous history of GDM were independent predictors for GDM diagnosis. ROC curve indicated that HbA1C levels ≥ 5.1% at 24-28 weeks gestation were associated with GDM. No difference was found in IL-6, tumor necrosis factor alpha (TNF-alpha) and CRP serum levels in women with and without GDM. Multivariate analysis showed that placental weight was significantly associated with APOs (p < 0.005), with a cut-off value of 610 grams as demonstrated by the ROC curve. Conclusion: Placental weight ≥ 610 grams and HbA1C ≥ 5.1% were found to be associated with APOs and GDM, respectively, and their evaluation should be part of prenatal care routine.

摘要
研究目的：本研究旨在探讨妊娠糖尿病（gestational diabetes mellitus, GDM）患者体内炎症细胞因子、胎盘重量、糖化血红蛋白与不良围产期结局（adverse perinatal outcomes, APOs）之间的关联。
对象与方法：本研究为一项前瞻性纵向观察性研究，于2004年4月至2005年11月在巴西包鲁（Bauru）开展。纳入研究的孕妇均为单胎妊娠，接受100g口服葡萄糖耐量试验（oral glucose tolerance test, OGTT），并于妊娠24~28周时检测其C反应蛋白（C-reactive protein, CRP）、白细胞介素（interleukin, IL）-6、肿瘤坏死因子α（tumor necrosis factor alpha, TNF-α）及糖化血红蛋白（glycated hemoglobin, HbA1c）水平。
结果：本研究共纳入176例孕妇，其中78例确诊为GDM，占比44.3%。多因素分析显示，HbA1c、年龄、体质量指数（body mass index, BMI）及GDM既往史是GDM诊断的独立预测因素。受试者工作特征曲线（receiver operating characteristic curve, ROC）结果表明，妊娠24~28周时HbA1c≥5.1%与GDM发病显著相关。合并GDM与未合并GDM的孕妇在IL-6、TNF-α及CRP血清水平上无统计学差异。多因素分析显示，胎盘重量与不良围产期结局存在显著关联（p<0.005），ROC曲线显示其最佳截断值为610g。
结论：胎盘重量≥610g与HbA1c≥5.1%分别与不良围产期结局及GDM发病相关，将二者的检测纳入产前常规护理流程具有临床必要性。