With the change in China’s second-child fertility policy, the numbers of older pregnant women and high-risk pregnancies have significantly increased, and the incidence of gestational diabetes mellitus (GDM) is likely to rise. GDM can cause a variety of adverse pregnancy outcomes, seriously threaten the safety of perinatal mothers and infants, and affect the long-term health of mothers and their offspring. Currently, the GDM screening period is between 24 to 28 weeks of pregnancy, but there are some shortcomings in screening at this time, since because of late diagnosis, the best time for intervention and treatment for some high-risk pregnant women may be delayed. Studies have shown that early prediction and early diagnosis of GDM is of great significance to improve pregnancy outcomes, so it is important to investigate early pregnancy prediction indexes of GDM to improve the screening efficiency for GDM and improve the management of GDM. It has been found that blood cell parameters, inflammatory factors, fat metabolism indices and liver enzyme metabolism markers have specific early predictive value for GDM. The application of these parameters combined with significant independent risk factors in the early prediction and early diagnosis of GDM will be of great value in the prevention and treatment of GDM and the prognosis of mothers and infants. This article reviews the development of routine blood test parameters during pregnancy and their value in the early diagnosis of GDM.
GDM is a disease consisting in any degree of glucose intolerance with onset during pregnancy. It can cause adverse pregnancy outcomes such as abortion, macrosomia, dystocia, neonatal hypoglycemia, and neonatal respiratory distress syndrome. The vast majority of pregnant women with GDM have no obvious symptoms in the first trimester of pregnancy. In China, the 75 g oral glucose tolerance test (OGTT) is performed between the 24th and 28th week of pregnancy for diagnosis of GDM. However, there are some shortcomings in screening at this time, since because of late diagnosis, the intervention and treatment for some high-risk pregnant women may be delayed. Also, the glucose tolerance test has some shortcomings, such as numerous blood sampling and a complex, time-consuming operation with poor patient compliance. Most scholars believe that early diagnosis and early intervention for GDM would help to improve maternal and infant outcomes and reduce pregnancy risks. Therefore, it would be of great value to bring together the risk factors for GDM with related blood tests to better predict GDM in the early stage of pregnancy. Studies have shown that early examination at 10–14 weeks of pregnancy may achieve the purpose of early detection and early treatment of GDM, using indicators such as body mass index (BMI), C-reactive protein (CRP), glycosylated hemoglobin (HbA1c), red blood cells (RBC), hemoglobin (Hb), white blood cells (WBC) and platelets (PLT), lipid metabolites, liver metabolites, etc. [1, 2, 3, 4]. Other factors, such as leptin, adiponectin, androgen and sex hormone binding protein, may have value in early prediction of GDM, but at present these serological indexes are not necessary for clinical examination [5]. Although there is no completely reliable method for early diagnosis and prediction of GDM, the analysis of some of the above blood test parameters may have clinical significance for early identification of GDM, and are easy for patients to accept. If these indicators can be combined, and linked to other risk factors, this may prove more effective in prediction of the occurrence of GDM, and enable early detection, early diagnosis and early treatment. My search methods: routine analysis of blood and GDM fasting blood-glucose and GDM and so on in pubmed and CNKI. This article reviews the relationship between these blood-based parameters and GDM.
Routine blood analysis is a procedure that pregnant women expect, the technology is mature, and it is one of the free antenatal examination items provided by the state. Routine blood analysis can simply and accurately assess the woman’s health and nutritional status.
At present, the etiology and pathogenesis of diabetes has not been fully
elucidated. In addition to insufficient insulin secretion by islet
Hb is an index used to evaluate the physiological status and anemia of pregnant
women during prenatal examination. In the past, a high Hb level was considered an
indicator of good nutritional status in pregnant women, but some studies have
found that the Hb level was a good predictor of pregnancy complications [10]. Lao et al. found that the incidence of GDM in pregnant women with a
high Hb level in early pregnancy (HB
There are different opinions on the relationship between PLT parameters and GDM,
though there are few relevant studies. It is generally believed that as pregnancy
progresses, the body gradually tends to a hypercoagulable state, and GDM patients
may also have changes in their blood coagulation system due to disorders of
glucose and lipid metabolism. Wang DN et al. showed that the PLT, mean platelet
volume (MPV) and platelet distribution width (PDW) of their GDM group were
(181.70
Routine blood analysis is a necessary item of early pregnancy assessment. In the past, we may have only paid attention to routine blood analysis to evaluate the nutritional status of pregnant women, but have ignored the early manifestations of other diseases. The above studies suggest that routine blood parameters may be of significance in the early detection of GDM, and is worthy of further study.
FPG is the most commonly used detection index for diabetes, since it
reflects the islet
HbAlc is a metabolite of Hb and glucose in the blood. Its synthesis is slow and
irreversible. The concentration of blood glucose in the environment of red blood
cells is proportional to the synthesis rate of HBAlc, while the lifespan of red
blood cells is only about 120 days. HbAlc only reflects the blood glucose level
of pregnant women for about three months. Fong et al. [19]
conducted a 2-year retrospective cohort study on the application of HbAlc to
early prediction of GDM. The results showed that 27.3% of the patients with
5.7% to 6.4% of HbAlc developed into GDM, while only 8.7% of those with HbA1c
CRP is an inflammatory marker synthesized by the liver and can be used as an important predictor of endothelial damage, cardiovascular events, obesity and neonatal infection. There is a correlation between blood CRP levels and blood glucose in the third trimester of pregnancy [22, 23]. Although there is no clear consensus on the pathogenesis of GDM, studies have shown that cytokine-mediated inflammation is closely related to GDM [24]. CRP is an acute phase reactive protein related to metabolic diseases. Oxidative stress mediated by insulin resistance will promote the synthesis of CRP, while the inflammatory response mediated by CRP will further promote insulin resistance. Both stimulate each other and participate in the occurrence and development of GDM [25]. Some studies have shown that the levels of CRP and HbAlc in patients with GDM are significantly higher than those in healthy pregnant women, and high levels of CRP and HbAlc are positively correlated with the occurrence of GDM [26]. The studies of Liao W and others have shown that there is a significant correlation between the levels of BMI, CRP, and HbA1c in pregnant women and the occurrence of GDM, and the analysis of these indexes could help to predict the occurrence of GDM at an early stage [27]. A prospective cohort study of CRP in pregnant women with impaired glucose tolerance (IGT) and normal glucose tolerance, conducted by Berggren [28], showed that the levels of CRP in pregnant women with IGT were higher, and there was a positive correlation between CRP and blood glucose levels, indicating that the maternal inflammatory response had been established in early pregnancy, and those women with higher CRP were more likely to develop GDM. However, after correcting for BMI, this correlation was not significant, so it was considered that CRP cannot accurately predict the occurrence of IGT in the third trimester of pregnancy.
Iron is one of the important trace elements in the human body and an important
component of red blood cells. Iron deficiency anemia is most likely to occur
during pregnancy. Some scholars believe that a high concentration of Hb may be
related to iron reserve level, because iron overload and its accompanying
oxidative stress are important components of the pathogenesis of Type 2 DM and
many other diseases, which can affect the synthesis and decomposition of insulin,
enhance lipid oxidation, reduce the utilization of glucose in tissues, and
increase hepatic gluconeogenesis, resulting in IR with the liver as an
intermediate [29]. SF is an important indicator of human iron reserve, and
the normal value for an adult female is 10
Adipose tissue is one of the most important endocrine organs in the human body, which can synthesize and secrete a variety of adipose factors with important metabolism-related functions. Insulin in the middle and third trimester of pregnancy can regulate blood lipid levels by reducing lipase activity. Increased insulin resistance in GDM patients leads to enhanced fat mobilization, and the interaction between placental estrogen, progesterone and placental prolactin leads to an abnormal increase of blood lipid levels [33].
Adiponectin is a factor derived from adipocytes and is sensitive to insulin. Leptin is a protein product encoded by the obesity gene and a circulating hormone secreted by adipose tissue. Nicholson et al. [34] studied 11464 women at 11–13 weeks of pregnancy, including 297 patients with GDM. It was found that the levels of adiponectin and sex hormone binding globulin in GDM patients were lower than those in normal controls. The detection rate for screening GDM according to mother’s age, BMI, race, GDM and macrosomia history was 61.6%, while the detection rate using adiponectin and sex hormone binding globulin was increased to 74.1%. It is suggested that adiponectin can be used as one of the early predictors of GDM. Other studies showed that the level of serum leptin in GDM pregnant women was significantly higher than that in normal pregnant women in early pregnancy, and the level of serum leptin was still significantly higher than that in non-GDM pregnant women after considering the influence of BMI, suggesting that leptin may be involved in the occurrence and development of GDM and could be used as one of the predictive factors for early screening of GDM [35]. The sensitivity of these two indicators is high, but they are not routine detection items, and the value of their clinical application is limited.
The blood lipid levels of women during pregnancy are elevated but the specific
mechanism is unknown. Most scholars believe that GDM patients not only have
abnormal glucose metabolism, but also have abnormal blood lipid metabolism.
Khosrowbeygi et al. found that low density lipoprotein cholesterol (LDL-C)/high
density lipoprotein cholesterol (HDL-C), TG/HDL-C and total cholesterol/HDL-C
ratio in patients with GDM were higher than those in normal pregnant women. There
was a significant positive correlation between TG/HDL-C and the IR
index [36]. The increase of TG was most significant in patients with GDM. The
blood lipid levels of well-controlled GDM patients were positively correlated
with neonatal birth weight, indicating that abnormal blood lipid levels in
patients with GDM could increase the transfer of maternal blood lipids to the
fetus, resulting in an increase in fetal fat quality and macrosomia [37]. Li
et al. [38] studied the blood lipid levels of 2488 pregnant women
at 6–15 weeks of pregnancy (average 11 weeks), of which 379 pregnant women
developed GDM. The results showed that there was a significant correlation
between the increase of triglycerides and GDM. After adjusting for confounding
factors, compared with those with triglyceride concentration
As the main site and target of glucose and insulin metabolism, the liver plays
an important role in the pathogenesis of diabetes. At present, liver enzymes are
the main index to reflect liver function. Common liver enzymes include alanine
aminotransferase (ALT), aspartate transaminase (AST) and
Impaired liver function often affects normal glucose metabolism and may even lead to impaired glucose tolerance or diabetes. Ryckman et al. [43] conducted a retrospective cohort study of 26350 pregnant women. The results showed that the risk of GDM in HBeAg positive pregnant women was higher than that in HBsAg positive pregnant women. Serum uric acid (UA) is a purine metabolite in the body. Studies have found that pregnant women with elevated maternal serum UA levels before 15 weeks of pregnancy have a higher incidence of GDM [44].
To sum up, China is a country with a large population. With the change in China’s fertility policy, a variety of risk factors of pregnancy are significantly increased, which may well increase the incidence of GDM. The growing epidemiological trend and disease burden of GDM may lead to serious public health problems. So far there is no clear standard for early screening of GDM, which could have a significant impact on early detection and early intervention of GDM. Most scholars believe that early diagnosis and treatment of GDM can reduce the short-term complications of mother and fetus. Some of the hematological indicators mentioned above are items that must be screened during pregnancy, and these indicators are directly or indirectly related to the occurrence of GDM. Therefore, best practice would integrate the above simple and easy screening indicators with other significant risk factors, use health statistics to establish an appropriate prediction model, identify the potential risk factors of pregnant women in the early stage of pregnancy, and formulate a practical and individualized pregnancy management plan, so as to achieve the purpose of early screening, early diagnosis, early intervention and early treatment for GDM, and improve the maternal and infant outcome.
GLL was responsible for writing the article, while NZZ was responsible for guiding, revising and reviewing the article. All authors contributed to editorial changes in the manuscript. All authors read and approved the final manuscript.
All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Fu Yang people’s hospital.
Thanks to the two reviewers for their help.
This research received no external funding.
The authors declare no conflict of interest.