title: First trimester screening for gestational diabetes mellitus by maternal factors and markers of inflammation.
abstract: OBJECTIVE
  To examine the potential role of maternal serum levels of tumor necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (Hs-CRP) in the first trimester of pregnancy in the prediction of gestational diabetes mellitus (GDM).
  
  
  METHODS
  Maternal serum TNF-α and Hs-CRP concentrations were measured in a case-control study of singleton pregnancies at 11-13 weeks' gestation, which included 200 cases that subsequently developed GDM and 800 unaffected controls. Measured levels of TNF-α and Hs-CRP were expressed as multiples of the median (MoM) after adjustment for maternal characteristics and history. The performance of screening for GDM by maternal factors and MoM values of TNF-α and Hs-CRP was evaluated by the area under the receiver operating characteristic curves (AUROC).
  
  
  RESULTS
  In the GDM group, compared to the normal group, the median TNF-α was significantly increased (1.303 MoM, interquartile range [IQR] 1.151-1.475 vs. 1.0 MoM, IQR 0.940-1.064; p=0.031) and the median Hs-CRP was not significantly different (1.113 MoM, IQR 0.990-1.250 vs. 1.0 MoM, IQR 0.943-1.060; p=0.084). In the prediction of GDM, the AUROC for maternal characteristics with TNF-α or Hs-CRP was not significantly different than the AUROC for maternal characteristics alone (p=0.5055 and p=0.2197, respectively).
  
  
  CONCLUSIONS
  In pregnancies that develop GDM there is no evidence of an inflammatory response at 11-13 weeks' gestation and the levels of serum TNF-α and Hs-CRP are not useful in first-trimester screening for GDM.
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Argyro
authors.initials: A
authors.lastname: Syngelaki
authors.affiliation: University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Gerard H A
authors.initials: GH
authors.lastname: Visser
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Krithinakis
authors.affiliation: Institute of Health Research, University of Exeter, Exeter, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Wright
authors.affiliation: Harris Birthright Research Centre of Fetal Medicine, King's College Hospital, London, UK. Electronic address: kypros@fetalmedicine.com.
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D016640:Diabetes, Gestational / Q000097:blood / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood*; D011247:Pregnancy; D011261:Pregnancy Trimester, First / Q000378:metabolism*; D011446:Prospective Studies; D012372:ROC Curve; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein
keywords: C-reactive protein; First trimester screening; Gestational diabetes mellitus; Tumor necrosis factor-α