Predicting gestational diabetes: choosing the optimal early serum marker.
OBJECTIVE
Serum markers measured early in pregnancy have been associated with the later diagnosis of gestational diabetes mellitus. To select an optimal early (<20 weeks) marker, we prospectively compared 3 serum markers examined simultaneously in a single cohort.


METHODS
A nested case-control design was used to evaluate the association of sex hormone-binding globulin, high-sensitive C-reactive protein, and measures of fasting glucose and insulin (homeostasis assessment model) obtained in the late first trimester and early second trimester of pregnancy with the diagnosis of gestational diabetes mellitus. Multivariate modeling and log likelihood ratios were used to identify the optimal biomarker associated with gestational diabetes mellitus.


RESULTS
In both first and second trimester samples, sex hormone-binding globulin was lower and high-sensitive C-reactive protein higher among women who subsequently developed gestational diabetes mellitus. Similarly an elevated second-trimester homeostasis assessment model was associated with gestational diabetes mellitus. Multivariate analysis suggested that sex hormone-binding globulin measured from nonfasting first-trimester sera was the best predictor of gestational diabetes mellitus in our population.


CONCLUSIONS
Among 3 biomarkers examined prospectively, first-trimester nonfasting sex hormone-binding globulin appeared to be the optimal marker to predict subsequent gestational diabetes mellitus.
Smirnakis
Karen V
KV
Renal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Plati
Alicia
A
Wolf
Myles
M
Thadhani
Ravi
R
Ecker
Jeffrey L
JL
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000032:analysis; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007333:Insulin Resistance; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012738:Sex Hormone-Binding Globulin / Q000378:metabolism*
D015415:Biomarkers; D001786:Blood Glucose; D012738:Sex Hormone-Binding Globulin; D002097:C-Reactive Protein