Study on the Interaction and Predictive Value of Early Pregnancy BMI and 25-(OH)D3 in Gestational Diabetes Mellitus

doi:10.12280/gjfckx.20240421

Abstract

Abstract:

Objective: To investigate the interaction and predictive value of body mass index (BMI) and 25-hydroxyvitamin D₃ [25-(OH)D₃] in gestational diabetes mellitus (GDM). Methods: A retrospective analysis was conducted on the clinical data of 102 pregnant women with GDM (GDM group) admitted to Beijing Aerospace General Hospital from January 2020 to January 2023. Another 102 healthy pregnant women during the same period were selected as the control group. The BMI and 25-(OH)D₃ levels in early pregnancy (8-12 weeks gestation), as well as fasting blood glucose (FBG), 1-hour postprandial blood glucose (1 h PBG), 2-hour postprandial blood glucose (2 h PBG) levels during the oral glucose tolerance test (OGTT), were compared between the two groups. The predictive value of BMI and 25-(OH)D₃ in GDM was evaluated, the interaction between BMI and 25-(OH)D₃ in GDM was analyzed. Results: The GDM group had higher FBG, 1 h PBG, 2 h PBG, and early pregnancy BMI levels than the control group, while the early pregnancy 25-(OH)D₃ levels in the GDM group were lower than those in the control group (all P<0.05). Early pregnancy BMI was positively correlated with FBG, 1 h PBG, and 2 h PBG levels during OGTT, whereas 25-(OH)D₃ was negatively correlated with FBG, 1 h PBG, and 2 h PBG levels during OGTT (all P<0.001). High BMI in early pregnancy was an independent risk factor for GDM (OR=1.285, 95%CI: 1.161-1.422, P<0.001), while high 25-(OH)D₃ was an independent protective factor against GDM (OR=0.924, 95%CI: 0.899-0.948, P<0.001). After adjusting for confounding factors, a positive interaction between early pregnancy BMI and 25-(OH)D₃ was observed in the risk of GDM, with a synergistic effect that was 2.096 times the sum of their individual effects (SI=2.096). Receiver operating characteristic (ROC) curve analysis showed that the combined prediction of GDM using early pregnancy BMI and 25-(OH)D₃ have an area under the curve (AUC) of 0.832, with a sensitivity of 76.47% and a specificity of 75.49%. Conclusions: The simultaneous presence of high BMI and low 25-(OH)D₃ levels in early pregnancy increases the risk of GDM, which can serve as a predictive indicators to provide guidance for the preventing GDM.

Key words: Diabetes, gestational, Body mass index, Calcifediol, Pregnancy trimester, first, Forecasting, Interactive relationships

LIU Zhao, ZHAO Lin-lin, LI Xia, WANG Xi-xian. Study on the Interaction and Predictive Value of Early Pregnancy BMI and 25-(OH)D₃ in Gestational Diabetes Mellitus[J]. Journal of International Obstetrics and Gynecology, 2024, 51(5): 541-545.

Figures/Tables 7

References 20

[1]	Kattini R, Hummelen R, Kelly L. Early Gestational Diabetes Mellitus Screening With Glycated Hemoglobin: A Systematic Review[J]. J Obstet Gynaecol Can, 2020, 42(11):1379-1384. doi: 10.1016/j.jogc.2019.12.015. pmid: 32268994
[2]	周欢珍, 徐学麟, 虞晓潇, 等. 血清ficolin-3、ALA水平与妊娠期糖尿病的相关性分析[J]. 中华内分泌外科杂志, 2022, 16(2):196-200. doi: 10.3760/cma.j.cn.115807-20210908-00273.
[3]	Bedell S, Hutson J, de Vrijer B, et al. Effects of Maternal Obesity and Gestational Diabetes Mellitus on the Placenta: Current Knowledge and Targets for Therapeutic Interventions[J]. Curr Vasc Pharmacol, 2021, 19(2):176-192. doi: 10.2174/1570161118666200616144512.
[4]	Hedeager Momsen AM, Høtoft D, Ørtenblad L, et al. Diabetes prevention interventions for women after gestational diabetes mellitus: an overview of reviews[J]. Endocrinol Diabetes Metab, 2021, 4(3):e00230. doi: 10.1002/edm2.230.
[5]	Rosinha P, Dantas R, Alves M, et al. Body mass index and gestational weight gain: relevance in gestational diabetes and outcomes-A retrospective cohort study[J]. Arch Endocrinol Metab, 2022, 66(2):261-268. doi: 10.20945/2359-3997000000463.
[6]	Milajerdi A, Abbasi F, Mousavi SM, et al. Maternal vitamin D status and risk of gestational diabetes mellitus: A systematic review and meta-analysis of prospective cohort studies[J]. Clin Nutr, 2021, 40(5):2576-2586. doi: 10.1016/j.clnu.2021.03.037. pmid: 33933723
[7]	Zeng Q, Zou D, Wei Y, et al. Association of vitamin D receptor gene rs739837 polymorphism with type 2 diabetes and gestational diabetes mellitus susceptibility: a systematic review and meta-analysis[J]. Eur J Med Res, 2022, 27(1):65. doi: 10.1186/s40001-022-00688-x. pmid: 35526059
[8]	American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2019[J]. Diabetes Care, 2019, 42(Suppl 1):S13-S28. doi: 10.2337/dc19-S002.
[9]	Martínez-Cruz CF, Guido-Campuzano MA, Ramírez-Maya AM, et al. Body mass index in offspring of mothers with diabetes mellitus: follow-up at 2, 4, 6, and 8 years of age[J]. Bol Med Hosp Infant Mex, 2021, 78(5):395-403. doi: 10.24875/BMHIM.20000311. pmid: 34570748
[10]	Lund A, Ebbing C, Rasmussen S, et al. Pre-gestational diabetes: Maternal body mass index and gestational weight gain are associated with augmented umbilical venous flow, fetal liver perfusion, and thus birthweight[J]. PLoS One, 2021, 16(8):e0256171. doi: 10.1371/journal.pone.0256171.
[11]	侯思捷. 妊娠期糖尿病早期体质量指数糖化血红蛋白及血红蛋白水平与妊娠结局的关系[J]. 中国药物与临床, 2022, 22(5):448-450. doi: 10.11655/zgywylc2022.05.016.
[12]	Zhang S, Liu H, Li N, et al. Relationship between gestational body mass index change and the risk of gestational diabetes mellitus: a community-based retrospective study of 41,845 pregnant women[J]. BMC Pregnancy Childbirth, 2022, 22(1):336. doi: 10.1186/s12884-022-04672-5.
[13]	Lou Y, Xiang L, Gao X, et al. Clinical Value of Early-Pregnancy Glycated Hemoglobin, Fasting Plasma Glucose, and Body Mass Index in Screening Gestational Diabetes Mellitus[J]. Lab Med, 2022, 53(6):619-622. doi: 10.1093/labmed/lmac058.
[14]	Harreiter J, Mendoza LC, Simmons D, et al. Vitamin D3 Supplementation in Overweight/Obese Pregnant Women: No Effects on the Maternal or Fetal Lipid Profile and Body Fat Distribution-A Secondary Analysis of the Multicentric, Randomized, Controlled Vitamin D and Lifestyle for Gestational Diabetes Prevention Trial (DALI)[J]. Nutrients, 2022, 14(18):3781. doi: 10.3390/nu14183781.
[15]	Gunasegaran P, Tahmina S, Daniel M, et al. Role of vitamin D-calcium supplementation on metabolic profile and oxidative stress in gestational diabetes mellitus: A randomized controlled trial[J]. J Obstet Gynaecol Res, 2021, 47(3):1016-1022. doi: 10.1111/jog.14629.
[16]	白盟盟, 江巍, 姜立敏, 等. 血清25-(OH)D₃、vaspin及Hcy对老年糖尿病肾病患者病变严重程度的评估价值[J]. 国际泌尿系统杂志, 2021, 41(4):674-677. doi: 10.3760/cma.j.cn431460-20201211-00027.
[17]	韩晓文, 孙桢, 李雪姣, 等. 25-(OH)D₃、脂联素、趋化素与妊娠期糖尿病患者胰岛素抵抗的相关性分析[J]. 国际生物医学工程杂志, 2022, 45(6):527-531. doi: 10.3760/cma.j.cn121382-20220708-00610.
[18]	Shang M, Zhao N. Early pregnancy vitamin D insufficiency and gestational diabetes mellitus[J]. J Obstet Gynaecol Res, 2022, 48(9):2353-2362. doi: 10.1111/jog.15333.
[19]	Ismail NA, Mohamed Ismail NA, Bador KM. Vitamin D in gestational diabetes mellitus and its association with hyperglycaemia, insulin sensitivity and other factors[J]. J Obstet Gynaecol, 2021, 41(6):899-903. doi: 10.1080/01443615.2020.1820462.
[20]	Tkachuk AS, Vasukova EA, Anopova AD, et al. Vitamin D Status and Gestational Diabetes in Russian Pregnant Women in the Period between 2012 and 2021: A Nested Case-Control Study[J]. Nutrients, 2022, 14(10):2157. doi: 10.3390/nu14102157.

组别	n	年龄（岁）	孕次（次）	产次（次）	流产次数（次）	糖尿病家族史	吸烟史	酗酒史	不良孕产史
GDM组	102	28.73±2.65	2.82±0.63	1.15±0.32	1.15±0.16	33（32.35）	12（11.76）	18（17.65）	15（14.71）
对照组	102	28.34±2.41	2.76±0.51	1.13±0.31	1.12±0.17	31（30.39）	13（12.75）	16（15.69）	17（16.67）
t或χ²		1.100	0.748	0.453	1.298	0.091	0.046	0.141	0.148
P		0.273	0.456	0.651	0.196	0.763	0.831	0.707	0.700

组别	n	年龄（岁）	孕次（次）	产次（次）	流产次数（次）	糖尿病家族史	吸烟史	酗酒史	不良孕产史
GDM组	102	28.73±2.65	2.82±0.63	1.15±0.32	1.15±0.16	33（32.35）	12（11.76）	18（17.65）	15（14.71）
对照组	102	28.34±2.41	2.76±0.51	1.13±0.31	1.12±0.17	31（30.39）	13（12.75）	16（15.69）	17（16.67）
t或χ²		1.100	0.748	0.453	1.298	0.091	0.046	0.141	0.148
P		0.273	0.456	0.651	0.196	0.763	0.831	0.707	0.700

组别	n	FBG （mmol/L）	1 h PBG （mmol/L）	2 h PBG （mmol/L）	BMI （kg/m²）	25-(OH)D₃ （ng/mL）
GDM组	102	5.23±0.44	10.55±0.73	8.92±0.51	25.02±3.36	21.25±13.10
对照组	102	4.36±0.37	8.39±0.58	6.24±0.64	22.25±3.56	37.80±17.81
t		15.264	23.398	33.075	5.384	7.562
P		<0.001	<0.001	<0.001	<0.001	<0.001

组别	n	FBG （mmol/L）	1 h PBG （mmol/L）	2 h PBG （mmol/L）	BMI （kg/m²）	25-(OH)D₃ （ng/mL）
GDM组	102	5.23±0.44	10.55±0.73	8.92±0.51	25.02±3.36	21.25±13.10
对照组	102	4.36±0.37	8.39±0.58	6.24±0.64	22.25±3.56	37.80±17.81
t		15.264	23.398	33.075	5.384	7.562
P		<0.001	<0.001	<0.001	<0.001	<0.001

因素	β	S.E.	Wald χ²	OR	95%CI	P
BMI（kg/m²）	0.250	0.052	23.472	1.285	1.161~1.422	<0.001
25-(OH)D₃（ng/mL）	-0.080	0.014	34.217	0.924	0.899~0.948	<0.001

Study on the Interaction and Predictive Value of Early Pregnancy BMI and 25-(OH)D₃ in Gestational Diabetes Mellitus

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BMI/ 25-(OH)D₃	对照组（n）	GDM组（n）	OR	95%CI	RERI	AP	SI
-/+	39	8	1.000	-	8.744	49.33%	2.096
-/-	28	34	5.920	1.992~8.204
+/+	24	20	4.063	1.356~7.825
+/-	11	40	17.727	7.943~27.617

指标	AUC	95%CI	P	截断值	敏感度（%）	特异度（%）
BMI（kg/m²）	0.701	0.631~0.771	<0.001	21.99	77.45	52.94
25-(OH)D₃（ng/mL）	0.770	0.707~0.832	<0.001	21.53	83.33	58.82
联合	0.832	0.778~0.886	<0.001	-	76.47	75.49

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