First trimester hepatic steatosis index as a predictor of gestational diabetes mellitus: a cohort study in Northwestern China

Abstract

To investigate the predictive value of the hepatic steatosis index (HSI) in the first trimester for gestational diabetes mellitus (GDM), and explore the association between HSI and the risk of developing GDM. A total of 2795 pregnant women were included in this cohort study. Maternal baseline data and basic laboratory data, including alanine aminotransferase, aspartate aminotransferase, fasting plasma glucose (FPG), and others were collected during 8-13 weeks of gestation. The 75-g oral glucose tolerance test was conducted at 24-28 weeks of gestation, and according to the criteria of American Diabetes Association, the participant would be diagnosed as GDM if one of the thresholds was met: fasting blood glucose ≥ 5.1 mmol/L, 1-h blood glucose ≥ 10.0 mmol/L, or 2-h blood glucose ≥ 8.5 mmol/L. The relationship between first-trimester HSI and GDM outcomes was analyzed by using Logistic Regression, Restricted Cubic Spline and Subgroup Analyses. The nomogram model including HSI, FPG and other factors was established, and diagnostic efficacies of the nomogram model, FPG, HSI, and white blood cell count (WBC) were analysed by using the receiver operating characteristic curve. 212 pregnant women were diagnosed with GDM among 2,795.After adjusting for the covariates, compared to women in the lowest quartile (Q1), those in the highest quartile group (Q4) of first-trimester HSI had a 2.328-fold risk of developing GDM (95% CI 1.262-4.295, p < 0.05). There was a positive nonlinear dose-response relationship between the first-trimester HSI and GDM (p for overall < 0.001; p for nonlinear = 0.010). Subgroup analyses found that HSI didn't interact with covariates such as age, gravidity, parity, etc. (p > 0.05). The diagnose efficacies of the nomogram model, HSI, FPG and WBC were 0.737 (95% CI 0.702-0.773), 0.696 (95% CI 0.658-0.734), 0.631 (95% CI 0.593-0.670), and 0.569 (95% CI 0.526-0.611), respectively. First-trimester HSI, FPG, WBC, and age may jointly predict the occurrence of GDM.

Keywords: Cohort study; First trimester; Gestational diabetes mellitus; Hepatic steatosis index; Predictive value.

Fig. 1

Flowchart of study participants.

Fig. 2

Relationship between HSI in the first trimester and risk of developing GDM.

Fig. 3

Establishment and validation of a risk prediction model for GDM in female participants (A) A nomogram model for GDM based on HSI, FPG, WBC, AGE; (B) ROC curve for evaluating the model, FPG, HSI and WBC for GDM.