A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes.
A Pre-Pregnancy Biomarker Risk Score Improves Prediction of Future Gestational Diabetes.
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DOI：
10.1210/js.2018-00200
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发表时间：
2018-10-01
影响因子：
4.1
通讯作者：
Hedderson MM
中科院分区：
文献类型：
--
作者：
Badon SE;Zhu Y;Sridhar SB;Xu F;Lee C;Ehrlich SF;Quesenberry CP;Hedderson MM
之前的研究尚未检验多种孕前生物标志物综合考虑后改善妊娠期糖尿病 (GDM) 预测的能力。制定孕前生物标志物风险评分并评估其与后续 GDM 的关联。一项巢式病例对照研究，在一组妇女中进行，她们在健康检查（1984 年至 1996 年）和随后怀孕（1984 年至 2009 年）期间收集了血清。与 GDM 相关的生物标志物分为高风险/低风险。综合医疗保健系统。两名对照者与每个 GDM 病例（n = 256 例）在检查时的年龄和年龄、怀孕年龄以及检查和首次怀孕之间的怀孕次数进行匹配。 GDM。高风险水平的性激素结合球蛋白 (SHBG；<44.2 nM)、葡萄糖 (>90 mg/dL)、总脂联素 (<7.2 μg/mL) 和稳态模型评估估计的胰岛素抵抗 (>3.9) 与 2.34 [95% 置信区间 (CI)：1.50、3.63]、2.03 (95% CI： 1.29, 3.19)、1.83 (95% CI: 1.16, 2.90) 和 1.67 (95% CI: 1.07, 2.62) 倍 GDM 几率，并包含在生物标志物风险评分中。生物标志物风险评分每增加一个单位，GDM 的几率就会增加 1.94 倍（95% CI：1.59，2.36）。仅包括 SHBG 和葡萄糖的生物标志物风险评分足以改善除既定风险因素（年龄、种族/族裔、体重指数、糖尿病家族史、既往 GDM；曲线下面积 = 0.73 vs 0.67，P = 0.002）之外的预测。生物标志物风险评分的预测能力超出了既定的风险因素，这表明临床上可以使用生物标志物风险评分来识别受孕前有 GDM 风险的女性，以制定有针对性的预防策略。
Previous studies have not examined the ability of multiple preconception biomarkers, considered together, to improve prediction of gestational diabetes mellitus (GDM). To develop a preconception biomarker risk score and assess its association with subsequent GDM. A nested case-control study among a cohort of women with serum collected as part of a health examination (1984 to 1996) and subsequent pregnancy (1984 to 2009). Biomarkers associated with GDM were dichotomized into high/low risk. Integrated health care system. Two controls were matched to each GDM case (n = 256 cases) on year and age at examination, age at pregnancy, and number of pregnancies between examination and index pregnancy. GDM. High-risk levels of sex hormone-binding globulin (SHBG; <44.2 nM), glucose (>90 mg/dL), total adiponectin (<7.2 μg/mL), and homeostasis model assessment-estimated insulin resistance (>3.9) were independently associated with 2.34 [95% confidence interval (CI): 1.50, 3.63], 2.03 (95% CI: 1.29, 3.19), 1.83 (95% CI: 1.16, 2.90), and 1.67 (95% CI: 1.07, 2.62) times the odds of GDM and included in the biomarker risk score. For each unit increase in the biomarker risk score, odds of GDM were 1.94 times greater (95% CI: 1.59, 2.36). A biomarker risk score including only SHBG and glucose was sufficient to improve prediction beyond established risk factors (age, race/ethnicity, body mass index, family history of diabetes, previous GDM; area under the curve = 0.73 vs 0.67, P = 0.002). The improved, predictive ability of the biomarker risk score beyond established risk factors suggests clinical use of the biomarker risk score in identifying women at risk for GDM before conception for targeted prevention strategies.