Title : A multifactorial study of maternal physical, psychological and health parameters for early prediction of gestational diabetes mellitus in pregnant women.
Abstract:
Gestational diabetes mellitus (GDM) is among the most common metabolic disorders of pregnancy with considerable maternal and neonatal morbidities. Early risk stratification in the first trimester may prevent adverse events with appropriate intervention. Many related factors are involved in the pathogenesis of GDM; therefore, a multi-faceted approach is necessary. The objective of this study was to determine the predictive value of maternal physical, psychological, and health characteristics in the first trimester for predicting the risk of developing GDM. A case-control study was carried out among 242 pregnant women enrolled during their first trimester. Maternal physical data, health parameters, and psychological well-being were evaluated with appropriate outcome measures. The participants were continuously followed up until 24–28 weeks of gestation, and then they were divided into cases and controls based on GDM diagnosis (IADPSG criteria). Univariate and multivariate regression models were utilised for statistical analyses to determine independent predictors of GDM.Among the included pregnant females, 33.7% women were found to have GDM. Women with GDM were significantly older, had greater BMI, WHR and total skinfold thickness (p < 0.001). Biochemical examination showed that the levels of HbA1c, fasting glucose, triglyceride, uric acid, and CRP, as well as thyroid antibodies, were high in the GDM group, while vitamin D levels were low. Physical inactivity and high perceived stress were significantly associated with GDM (p < 0.001). Independent predictors were: stress, low physical activity, HbA1c and family history of diabetes in univariate as well as multivariable analysis. The penalised logistic regression model including stress, activity and HbA1c had excellent discrimination (AUC = 0.999). These results emphasise the complex aetiology of GDM, including metabolic, lifestyle and psychological determinants. This study emphasises the need for a multifactorial model for the early prediction of GDM.
