Gestasyonel Diabetes Mellitus Riskinin Belirlenmesi: İlk İki Trimesterde Ölçülen Tam Kan Sayımı Değişkenlerinin Rolünün Değerlendirilmesi

Abstract

Amaç: Gestasyonel diyabetes mellitus (GDM) riskini öngörmede birinci ve ikinci trimester tam kan sayımı (CBC) parametrelerinin değerini değerlendirmek. Gereç ve Yöntem: Bu retrospektif vaka kontrol çalışması, Ocak 2017 ile Aralık 2018 tarihleri arasında XXX gerçekleştirildi. GDM'li gebeler ve sağlıklı gebelerden oluşan çalışma grubunun CBC ve biyokimya sonuçları, CBC parametrelerinden hesaplanan çeşitli indeksler ve diğer veriler tıbbi kayıtlardan elde edildi. Bulgular: Yaş (p<0,001), açlık kan glukozu (p<0,001), eritrosit sayısı (RBC) (p<0,001), hemoglobin (p=0,015), hematokrit (p<0,001), eritrosit dağılım genişliği (RDW) (p=0,001), RDW-trombosit oranı (p<0,001) ve 75 g OGTT testleri için tüm glukoz seviyeleri (tümü için p<0,001) GDM'li kadınlarda kontrollere kıyasla daha yüksekti. GDM'li gebelerde trombosit sayısı (p=0,002), trombosit/lenfosit oranı (p=0,006) ve trombosit/MPV oranı (p=0,021) sağlıklı gebelere göre daha düşüktü. Yüksek yaş (p<0,001), yüksek RBC (p=0,002) ve yüksek RDW-trombosit oranı (p<0,001) GDM için anlamlı bağımsız risk faktörleri olarak bulundu. GDM’nin öngörülmesinde, eğri altında kalan alan (AUC) değerleri en yüksek olan parametreler RBC (AUC:0,619, %95GA: 0,566-0,673; p<0,001) ve RDW-trombosit oranı (AUC:0,610, %95GA: 0,556-0,663; p<0,001) idi. RBC %57,0 duyarlılık ve %63,4 özgüllük gösterdi ve RDW-trombosit oranı %31,7 duyarlılık ve %89,2 özgüllük gösterdi. Sonuç: Gebeliğin erken döneminde saptanan artmış RBC ve artmış RDW-trombosit oranı, GDM riskinin artmasının bağımsız prediktörleridir. GDM riskinin erken belirleyicilerini değerlendiren kapsamlı prospektif çalışmalara ihtiyaç vardır.

Keywords

• Gestasyonel diyabet
• Risk
• Tam kan sayımı

Determining the Risk of Gestational Diabetes Mellitus: Evaluation of the Role of Complete Blood Count Variables Measured in the First Two Trimesters

Abstract

Objective: To evaluate the value of first and second trimester complete blood count (CBC) parameters in predicting the risk of gestational diabetes mellitus (GDM). Materials and Method: This study was carried out from January 2017 to December 2018 at the XXX. The CBC and biochemistry results, various indices calculated from CBC parameters, and other data of the study group consisting of pregnant women with and without GDM were obtained from medical records. Results: Age (p<0.001), fasting glucose (p<0.001), red blood cell count (RBC) (p<0.001), hemoglobin (p=0.015), hematocrit (p<0.001), red cell distribution width (RDW) (p=0.001), RDW-to-platelet ratio (p<0.001), and all glucose levels for 75 g OGTT tests (p<0.001 for all) were higher in women with GDM compared to controls. Platelet count (p=0.002), platelet-to-lymphocyte ratio (p=0.006) and platelet-to-MPV ratio (p=0.021) were lower in pregnant women with GDM compared to those without. We found high age (p<0.001), high RBC (p=0.002) and high RDW-to-platelet ratio (p<0.001) were independently associated with GDM. For the prediction of GDM, the area under curve (AUC) values were highest for RBC (AUC:0.619, 95%CI: 0.566-0.673; p<0.001) and RDW-to-platelet ratio (AUC:0.610, 95%CI: 0.556-0.663; p<0.001). RBC showed 57.0% sensitivity and 63.4% specificity, while RDW-to-platelet ratio demonstrated 31.7% sensitivity and 89.2% specificity. Conclusion: Increased RBC and increased RDW-to-platelet ratio measured in the early period of pregnancy are independent predictors of higher GDM risk. Comprehensive prospective studies assessing early determinants of GDM risk are needed.

Keywords

• Gestational Diabetes
• Risk
• Complete blood count

References

1. 1. Association AD. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(Supplement_1):S13-S27.
2. 2. Abell SK, De Courten B, Boyle JA, Teede HJ. Inflammatory and other biomarkers: role in pathophysiology and prediction of gestational diabetes mellitus. Int J Mol Sci. 2015;16(6):13442-73.
3. 3. Cho N, Shaw J, Karuranga S, Huang Y, Da Rocha Fernandes J, Ohlrogge A, Malanda B. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-81.
4. 4. Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab. 2018;29(11):743-54.
5. 5. Sacks DA, Hadden DR, Maresh M, Deerochanawong C, Dyer AR, Metzger BE, Lowe LP, Coustan DR, Hod M, Oats JJ. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel–recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care. 2012;35(3):526-8.
6. 6. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19(11):3342.
7. 7. Mpondo BCT, Ernest A, Dee HE. Gestational diabetes mellitus: challenges in diagnosis and management. J Diabetes Metab Disord. 2015;14(1):42.
8. 8. Shaarbaf Eidgahi E, Nasiri M, Kariman N, Safavi Ardebili N, Salehi M, Kazemi M, Zayeri F. Diagnostic accuracy of first and early second trimester multiple biomarkers for prediction of gestational diabetes mellitus: a multivariate longitudinal approach. BMC Pregnancy Childbirth. 2022;22(1):13.

9. 9. Amini M, Kazemnejad A, Zayeri F, Montazeri A, Rasekhi A, Amirian A, Kariman N. Diagnostic accuracy of maternal serum multiple marker screening for early detection of gestational diabetes mellitus in the absence of a gold standard test. BMC Pregnancy Childbirth. 2020;20(1):375.
10. 10. Erikçi AA, Muhçu M, Dündar Ö, Öztürk A. Could mean platelet volume be a predictive marker for gestational diabetes mellitus? Hematology. 2008;13(1):46-8.
11. 11. Bozkurt N, Yılmaz E, Biri A, Taner Z, Himmetoğlu Ö. The mean platelet volume in gestational diabetes. J Thromb Thrombolysis. 2006;22(1):51-4.
12. 12. Kong M, Zhang H, Liu X, Ge Y, Zhang Z, Zhao R, Li Y, Huang S, Xiong G, Yang X. Association of maternal neutrophil count in early pregnancy with the development of gestational diabetes mellitus: a prospective cohort study in China. Gynecol Endocrinol. 2022;38(3):258-62.
13. 13. Huang Y, Chen X, You ZS, Gu F, Li L, Wang D, Liu J, Li Y, He S. The value of first-trimester platelet parameters in predicting gestational diabetes mellitus. J Matern Fetal Neonatal Med. 2022;35(11):2031-5.
14. 14. Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36(4):399-406.
15. 15. Mcpherson RA, Pincus MR. Henry's clinical diagnosis and management by laboratory methods E-book, Elsevier Health Sciences, 2021.
16. 16. Savvidou M, Nelson SM, Makgoba M, Messow C-M, Sattar N, Nicolaides K. First-trimester prediction of gestational diabetes mellitus: examining the potential of combining maternal characteristics and laboratory measures. Diabetes. 2010;59(12):3017-22.
17. 17. Mertoglu C, Gunay M, Gungor M, Kulhan M, Kulhan NG. A study of inflammatory markers in gestational diabetes mellitus. Gynecol Obstet Reprod Med. 2019;25(1):7-11.
18. 18. Colak E, Ozcimen EE, Ceran MU, Tohma YA, Kulaksızoglu S. Role of mean platelet volume in pregnancy to predict gestational diabetes mellitus in the first trimester. J Matern Fetal Neonatal Med. 2020;33(21):3689-94.
19. 19. Wang Y, Yang P, Yan Z, Liu Z, Ma Q, Zhang Z, Wang Y, Su Y. The relationship between erythrocytes and diabetes mellitus. J Diabetes Res. 2021;2021:6656062
20. 20. Yong HY, Shariff ZM, Yusof BNM, Rejali Z, Tee YYS, Bindels J, Van Der Beek EM. Early pregnancy hemoglobin is associated with the risk of gestational diabetes mellitus: a retrospective cohort study. Br J Nutr. 2022:1-8.
21. 21. Wang C, Lin L, Su R, Zhu W, Wei Y, Yan J, Feng H, Li B, Li S, Yang H. Hemoglobin levels during the first trimester of pregnancy are associated with the risk of gestational diabetes mellitus, pre-eclampsia and preterm birth in Chinese women: a retrospective study. BMC Pregnancy Childbirth. 2018;18(1):263.
22. 22. Güdücü N, Görmüş U, Herman İ, Yİğİter AB, Dünder İ. Mean platelet volume in gestational diabetes mellitus. İstanbul Bilim Üniversitesi Florence Nightingale Tıp Dergisi. 2015;1(1):7-10.
23. 23. Şentürk HSA, Şentürk M, Kara OF. The role of the platelet profile in the prediction of gestational diabetes. Kastamonu Med J. 2021;1(2):50-4.
24. 24. Zhang Y, Zhang Y, Zhao L, Shang Y, He D, Chen J. Distribution of complete blood count constituents in gestational diabetes mellitus. Medicine. 2021;100(23):e26301.
25. 25. Yang H, Zhu C, Ma Q, Long Y, Cheng Z. Variations of blood cells in prediction of gestational diabetes mellitus. J Perinat Med. 2015;43(1):89-93.
26. 26. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med. 2012;50(4):635-41.
27. 27. Nada AM. Red cell distribution width in type 2 diabetic patients. Diabetes Metab Syndr Obes. 2015;8:525-33.
28. 28. Eren P, Beyazit F. Gestasyonel Diabetes Mellituslu Hastalarda Basit Hematolojik Belirteçlerin Değerlendirilmesi: Vaka-Kontrol Çalışması. Bozok Tıp Dergisi. 2021;11(3):19-24.
29. 29. Yılmaz ZV, Yılmaz E, İçer B, Küçüközkan T. Association of complete blood count parameters with gestational diabetes mellitus. Gynecol Obstet Reprod Med. 2017;23(2):65-9.
30. 30. Sahbaz A, Cicekler H, Aynioglu O, Isik H, Ozmen U. Comparison of the predictive value of plateletcrit with various other blood parameters in gestational diabetes development. J Obstet Gynaecol. 2016;36(5):589-93.
31. 31. Fashami MA, Hajian S, Afrakhteh M, Khoob MK. Is there an association between platelet and blood inflammatory indices and the risk of gestational diabetes mellitus? Obstet Gynecol Sci. 2020;63(2):133-40.
32. 32. Baldane S, Ipekci SH, Kebapcilar A. Relationship between insulin resistance and mean platelet volume in gestational diabetes mellitus. J Lab Physicians. 2015;7(02):112-5.