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Published on: February 28, 2013
Metabolic biomarkers in early detection of gestational diabetes mellitus: a prospective diagnostic accuracy study
Alihan Tigli1, Yakup Baykus1, Rulin Deniz1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Bandırma OnYedi Eylül University, Bandırma, Türkiye.
Insights
Investigating first trimester inflammatory markers and metabolic indices for gestational diabetes mellitus (GDM) prediction revealed limited diagnostic value. Current markers are insufficient for early GDM detection, emphasizing the need for more specific biomarkers.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Clinical Chemistry
Background:
- Early diagnosis of gestational diabetes mellitus (GDM) is crucial for preventing adverse maternal and neonatal outcomes.
- Inflammatory and metabolic markers in early pregnancy are being explored as potential predictors of GDM.
- Existing diagnostic methods for GDM require timely evaluation for improved predictive accuracy.
Purpose of the Study:
- To assess the predictive value of first-trimester inflammatory markers (NLR, PLR, MLR, NMR) and HDL-based inflammation indicators (LHR, MHR, GHR).
- To investigate the utility of metabolic indices such as Atherogenic Index of Plasma (AIP) and Triglyceride-Glucose Index (TyG) for early GDM prediction.
- To determine if these markers can aid in the early diagnosis of GDM, complementing existing screening methods.
Main Methods:
- A prospective diagnostic accuracy study involving 250 pregnant women between December 2024 and October 2025.
- Collection of first-trimester complete blood count, fasting glucose, and lipid profiles.
- Calculation of NLR, PLR, MLR, NMR, LHR, MHR, GHR, AIP, and TyG indices, with GDM diagnosis confirmed by OGTT at 24-28 weeks.
Main Results:
- The prevalence of GDM was 18.0%, with significantly higher maternal age, BMI, and parity in the GDM group.
- No significant differences were observed in the average values of the investigated biomarkers between the GDM and non-GDM groups.
- Receiver Operating Characteristic (ROC) analysis showed Area Under the Curve (AUC) values below 0.70 for all tested markers, indicating limited predictive performance.
Conclusions:
- First-trimester inflammatory markers and metabolic indices (LHR, MHR, AIP, TyG) demonstrate limited value for predicting GDM.
- These markers are currently insufficient for standalone early GDM diagnosis.
- The Oral Glucose Tolerance Test (OGTT) remains the most reliable diagnostic method, and further research into more specific biomarkers and multicenter studies is warranted.
Background And Objectives:
Early diagnosis of gestational diabetes mellitus (GDM) is essential for the prevention of maternal and neonatal complications. In this study, we aimed to investigate the value of first trimester inflammatory markers (Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil-to-Monocyte Ratio (NMR)), HDL-based metabolic inflammation indicators (Lymphocyte-to-High-Density Lipoprotein Cholesterol Ratio (LHR), Monocyte-to-High-Density Lipoprotein Cholesterol Ratio (MHR), Granulocyte-to-High-Density Lipoprotein Cholesterol Ratio (GHR)) and metabolic indices (Atherogenic Index of Plasma (AIP), Triglyceride-Glucose Index (TyG)) in predicting GDM.
Materials And Methods:
Between December 2024 and October 2025, 250 pregnant women were included in this prospective diagnostic accuracy study conducted at Bandırma Onyedi Eylül University Hospital. First trimester (10-14 weeks) complete blood count, fasting glucose and lipid profile were recorded. NLR, PLR, MLR, NMR, LHR, MHR, GHR, AIP and TyG indices were calculated. GDM was diagnosed with 75 g Oral Glucose Tolerance Test (OGTT) at 24-28 weeks according to International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Diagnostic performance was evaluated by ROC analysis and significance level was taken as p < 0.05.
Results:
The prevalence of GDM was 18.0% (n = 45). Age, body weight, Body Mass Index (BMI) and parity were significantly higher in the GDM group (p < 0.05). Biomarker averages did not differ significantly between the two groups (p > 0.05). According to Receiver Operating Characteristic (ROC) analysis, the Area Under the Curve (AUC) values were NLR (0.470), PLR (0.490), MLR (0.474), NMR (0.481), LHR (0.567), MHR (0.506), GHR (0.466), AIP (0.561) and TyG (0.573). None of them exceeded the threshold value of 0.70.
Conclusion:
LHR, MHR, AIP and TyG indices are of limited value in predicting GDM. These markers cannot be used alone in the early period. OGTT is still the most reliable diagnostic method. More specific biomarkers and multicenter studies are needed for early diagnosis.
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