The diagnostic model for early detection of gestational diabetes mellitus and gestational diabetic nephropathy

Abstract

Background: Gestational diabetes mellitus (GDM) and gestational diabetic nephropathy (GDN) have become an increasingly serious problem worldwide, which can cause a large number of adverse pregnancy consequences for mothers and infants. However, the diagnosis of GDM and GDN remains a challenge due to the lack of optimal biomarkers, and the examination has high requirements for patient compliance. We aimed to establish a simple early diagnostic model for GDM and GDN.

Methods: We recruited 50 healthy pregnant (HP), 99 GDM patients, 99 GDN patients at Daping Hospital. Renal function indicators and blood cell indicators were collected for all patients.

Results: Compared with HP, GDM, and GDN patients exhibited significantly higher urea/creatinine ratio and NEU. The diagnostic model1 based on the combination of urea/creatinine ratio and NEU was built using logistic regression. Based on receiver operating characteristic curve analysis, the area under the curve (AUC) of the diagnostic model was 0.77 (0.7, 0.84) in distinguishing GDM from HP, and the AUC of the diagnostic model was 0.94 (0.9, 0.97) in distinguishing GDN from HP. Meanwhile, the diagnostic model2 based on the combination of β2-mG, PLT, and NEU in GDM and GDN patients was built using logistic regression, and the area under the ROC curve (AUC ROC) was 0.79 (0.73, 0.85), which was larger than the individual biomarker AUC.

Conclusion: Our study demonstrated that the diagnostic model established by the combination of renal function indicators and blood cell indicators could facilitate the differential diagnosis of GDM and GDN patients.

Keywords: biomarker; blood cell indicators; diagnostic model; gestational diabetes mellitus; gestational diabetic nephropathy; renal function indicators.

FIGURE 1

The result of biomarkers in HP, GDM, and GDN. (A) Violin plot showing the results of biomarkers in HP (n = 50), GDM (n = 99), and GDN (n = 98). Horizontal lines indicate the median and interquartile range. *p < 0.05, **p < 0.01, ***p < 0.001, ns, no significance (Mann–Whitney U test)

FIGURE 2

Performance of potential indicators and diagnostic models in differentiating HP, GDM and GDN. (A) ROC analysis showing the performance of various indicators in discriminating GDM patients from HP. (B) ROC analysis showing the performance of various indicators in discriminating GDN patients from HP. (C) ROC analysis showing the performance of various indicators in discriminating GDN patients from GDM. AUC, area under the curve; GDM, Gestational diabetes mellitus; GDN, Gestational diabetic nephropathy; HP, Healthy Pregnancy