title: Relationship between High Serum Cystatin C Levels and the Risk of Gestational Diabetes Mellitus.
abstract: OBJECTIVE
  Serum cystatin C (CysC) has recently been shown to be associated with the incidence of type 2 diabetes mellitus (T2DM) and progression to the pre-diabetic state. The aim of this study was to explore the relationship between serum CysC and the risk of gestational diabetes mellitus (GDM) in Chinese pregnant women.
  
  
  METHODS
  This cross-sectional study consisted of 400 pregnant women including 111 with GDM and 289 with normal glucose tolerance at 24-28 weeks of gestation. The subjects were further divided into four groups according to the CysC quartiles, and their clinical characteristics were compared. The serum CysC concentration was measured using immunoturbidimetry and the degree of insulin resistance was assessed by the homeostasis model assessment of insulin resistance (HOMA-IR).
  
  
  RESULTS
  Serum CysC levels were significantly higher in pregnant women with GDM than in the healthy pregnant women[1.0(0.8-1.8) vs 0.7(0.6-1.0), P<0.01). The Spearman's correlation analysis showed that serum CysC was positively associated with HOMA-IR(r = 0.118, P<0.05) and the occurrence of GDM(r = 0.348, P<0.01). The pregnant women were divided into quartiles according to their serum CysC concentrations. Compared to the first quartile, pregnant women in Q2 (OR, 2.441; P = 0.025), Q3 (OR, 3.383; P = 0.001) and Q4 (OR, 5.516; P<0.001) had higher risk of GDM after adjusted for age, BMI, HbA1c and HOMA-IR. Further, with a rise in the serum CysC, there was an increasing trend in the HOMA-IR levels (P<0.05). A binary logistic regression analysis after adjusting for other confounding variables revealed a significant and independent association between serum CysC and GDM [OR = 14.269; 95% confidence interval, 4.977-40.908, P<0.01].The receiver operating characteristic curve analysis revealed that the optimal cutoff point for serum CysC to indicate GDM was 0.95 mg/L.
  
  
  CONCLUSIONS
  Serum CysC is significantly and independently associated with insulin resistance and GDM. It may be a helpful biomarker to identify the risk of GDM in Chinese pregnant women.
authors: Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors: Weijing
authors: W
authors: Zhao
authors: Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors: Jiemin
authors: J
authors: Pan
authors: Department of Obstetrics and Gynecology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Huaping
authors: H
authors: Li
authors: Department of Obstetrics and Gynecology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Yajuan
authors: Y
authors: Huang
authors: Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors: Fang
authors: F
authors: Liu
authors: Department of Obstetrics and Gynecology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors: Minfang
authors: M
authors: Tao
authors: Shanghai Key Laboratory of Diabetes, Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai, China.
authors: Weiping
authors: W
authors: Jia
mesh_terms: D000328:Adult; D015415:Biomarkers; D001786:Blood Glucose; D003430:Cross-Sectional Studies; D055316:Cystatin C / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance; D016017:Odds Ratio; D011247:Pregnancy; D015995:Prevalence; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D055316:Cystatin C; D007328:Insulin