Relationship between inflammatory markers, glycated hemoglobin and placental weight on fetal outcomes in women with gestational diabetes

Braga, Fernanda Oliveira; Negrato, Carlos Antonio; Matta, Maria de Fátima Bevilacqua da; Carneiro, João Régis Ivar; Gomes, Marília Brito

doi:10.20945/2359-3997000000099

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Original Article • Arch. Endocrinol. Metab. 63 (1) • Feb 2019 • https://doi.org/10.20945/2359-3997000000099 copy

Relationship between inflammatory markers, glycated hemoglobin and placental weight on fetal outcomes in women with gestational diabetes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

The aim of this study was to evaluate the relationship between inflammatory cytokines, placental weight, glycated hemoglobin and adverse perinatal outcomes (APOs) in women with gestational diabetes mellitus (GDM).

Subjects and methods:

This was a prospective, longitudinal and observational study conducted from April 2004 to November 2005 in Bauru, Brazil. Included patients had singleton pregnancies and performed a 100 g OGTT and had the levels of C-reactive protein (CRP), interleukin (IL)-6, TNF alfa and glycated hemoglobin (HbA1c) determined at 24-28^th gestation weeks.

Results:

A total of 176 patients were included, of whom 78 had the diagnosis of GDM (44.3%). Multivariate analysis demonstrated that HbA1c, age, body mass index (BMI) and previous history of GDM were independent predictors for GDM diagnosis. ROC curve indicated that HbA1C levels ≥ 5.1% at 24-28 weeks gestation were associated with GDM. No difference was found in IL-6, tumor necrosis factor alpha (TNF-alpha) and CRP serum levels in women with and without GDM. Multivariate analysis showed that placental weight was significantly associated with APOs (p < 0.005), with a cut-off value of 610 grams as demonstrated by the ROC curve.

Conclusion:

Placental weight ≥ 610 grams and HbA1C ≥ 5.1% were found to be associated with APOs and GDM, respectively, and their evaluation should be part of prenatal care routine.

Keywords
Gestational diabetes; inflammation; cytokines; placenta; macrosomia; preterm birth

Variable	GDM			Normal OGTT			p value^a a Mann-Whitney test.
Variable	N	Median	IQR	N	Median	IQR	p value^a a Mann-Whitney test.
Age (years)	78	31.0	29.0-37.0	98	27.5	24-32	< 0.0001
Education level (years)	78	11.0	8.0-12.3	98	12.0	10.0-15.0	0.004
Family income (Brazilian minimum wage)	78	2.65	1.67-7.9	98	6.0	3.0-12.0	0.0001
Height (m)	78	1.61	1.58-1.67	98	1.65	1.59-1.7	0.010
Legs length (cm)	78	73.3	71.0-76.1	98	75.0	72.5-78.6	0.011
Legs/height ratio (%)	78	45.6	44.5-46.4	98	45.8	45.0- 46.7	0.089
Weight (kg)	78	70.0	62.0-87.5	98	64.0	57.8-72.0	0.0009
Body Mass Index (kg/m²)	78	27.8	23.6-32.1	98	22.8	20.9-27.3	< 0.0001
Systolic blood pressure (mmHg)	78	120	110-120	98	110	100-120	0.0001
Diastolic blood pressure (mmHg)	78	80	70-80	98	70	70-80	< 0.0001
Fasting glycemia (mg/dL)	72	90.5	82.6-103.3	89	74.0	67.0-79.0	< 0.0001
HbA1c (%)	72	5.68	5.09-6.10	88	4.8	4.41-5.20	< 0.0001
Total cholesterol (mg/dL)	72	209.0	191.0-238.0	89	230.0	206.0-261.0	0.001
LDL cholesterol (mg/dL)	70	112.0	89.0-141.0	89	127.0	110.0-153.0	0.008
HDL cholesterol (mg/dL)	72	56.3	47.6-66.9	89	64.0	54.3-76.7	0.002
VLDL cholesterol (mg/dL)	71	37.0	27.4-44.9	89	37.0	25.6-48.0	0.90
Triglycerides (mg/dL)	72	185.0	132.0-227.0	89	185.0	128.0-240.0	0.78
IL-6 (pg/mL)	78	0.175	0.120-0.298	98	0.155	0.100-0.325	0.77
CRP (mg/dL)	78	0.585	0.335-1.123	98	0.530	0.250-0.883	0.40
TNF alpha (pg/mL)	78	0.230	0.130-0.330	98	0.200	0,130-0.310	0.76

Variable	Category	GDM		Normal OGTT		P value
Variable	Category	N	%	N	%	P value
Polycystic ovary syndrome	Yes No	21 57	26.9 73.1	39 59	39.8 60.2	0.073
Acanthosis	Yes No	50 28	64.1 35.9	27 71	27.6 72.4	< 0.0001
Smoking	Yes No	6 72	7.7 92.3	7 91	7.1 92.9	0.15
GDM	Yes No	13 65	16.7 83.3	6 92	6.1 93.9	0.025
Abortion	Yes No	21 57	26.9 73.1	25 73	25.5 74.5	0.83
Stillbirth	Yes No	3 75	3.8 96.2	2 96	2.0 98.0	0.39
Babies’ mal formation	Yes No	5 73	6.4 93.6	3 95	3.1 97.0	0.24
Polyhydramnios	Yes No	26 52	33.3 66.7	30 68	30.6 69.4	0.70
Multiple pregnancy	Yes No	0 78	0.0 100.0	4 94	4.1 95.9	0.094
Respiratory distress syndrome	Yes No	5 73	6.4 93.6	1 97	1.0 99.0	0.061
Preterm birth	Yes No	13 65	16.7 83.3	10 88	10.2 89.8	0.21
Neonatal hypoglycemia	Yes No	0 78	0.0 100.0	0 98	0.0 100.0	NA
Icterus	Yes No	7 71	9.0 91.0	5 93	5.1 94.9	0.31
< 2,500g newborn	Yes No	6 72	7.7 92.3	7 91	7.1 92.9	0.89
> 4,000g newborn	Yes No	9 69	11.5 88.5	11 87	11.2 88.8	0.95
Pregnancy induced hypertension	Yes No	12 66	15.4 84.6	11 87	11.2 88.8	0.42
Newborn death	Yes No	3 75	3.8 96.2	0 98	0.0 100.0	0.085
Familial DM	Yes No	65 13	83.3 16.7	72 26	73.5 26.5	0.12

Variable	GDM			Normal OGTT			p value^a a Mann-Whitney test.
Variable	N	Median	IQR	N	Median	IQR	p value^a a Mann-Whitney test.
Newborn weight (grams)	77	3,195	2935-3555	94	3,275	2,993-3,564	0.36
Length (cm)	77	48.0	46.5-49.0	94	48.5	47.0-50.0	0.18
Head circumference (cm)	76	35.0	33.5-35.0	93	35.0	34.0-36.0	0.24
Thoracic circumference (cm)	76	33.0	32.0-34.0	93	33.2	32.0-34.0	0.96
Waist circumference (cm)	73	32.0	30.0-33.0	78	32.0	30.0-33.0	0.72
Apgar T1 score	77	9	8-9	93	9	8-9	0.68
Apgar T2 score	77	10	9-10	93	10	9-10	0.92
Apgar T5 score	77	10	10-10	93	10	10-10	0.52
Placental weight (grams)	72	600	500-684	78	580	518-713	0.65

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[1] Correspondence to: Carlos Antonio Negrato Associação dos Diabéticos de Bauru Rua Saint Martin, 27-07 17012-433 – Bauru, SP, Brasil carlosnegrato@uol.com.br