Powe Camille E
Diabetes Unit, Division of Endocrinology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 340, Boston, MA, 02114, USA.
Curr Diab Rep. 2017 Feb;17(2):12. doi: 10.1007/s11892-017-0834-y.
Universal oral glucose tolerance-based screening is employed to identify pregnant women with gestational diabetes mellitus (GDM), as treatment of this condition decreases the risk of associated complications. A simple and accurate blood test which identifies women at low or high risk for GDM in the first trimester would have the potential to decrease costs and improve outcomes through prevention or treatment. This review summarizes published data on early pregnancy biomarkers which have been tested as predictors of GDM.
A large number of first-trimester biochemical predictors of GDM have been reported, mostly in small case-control studies. These include glycemic markers (fasting glucose, post-load glucose, hemoglobin A1C), inflammatory markers (C-reactive protein, tumor necrosis factor-alpha), insulin resistance markers (fasting insulin, sex hormone-binding globulin), adipocyte-derived markers (adiponectin, leptin), placenta-derived markers (follistatin-like-3, placental growth factor, placental exosomes), and others (e.g., glycosylated fibronectin, soluble (pro)renin receptor, alanine aminotransferase, ferritin). A few large studies suggest that first-trimester fasting glucose or hemoglobin A1C may be useful for identifying women who would benefit from early GDM treatment. To translate the findings from observational studies of first-trimester biomarkers for GDM to clinical practice, trials or cost-effectiveness analyses of screening and treatment strategies based on these novel biomarkers are needed.
采用基于口服葡萄糖耐量的通用筛查方法来识别患有妊娠期糖尿病（GDM）的孕妇，因为对这种疾病的治疗可降低相关并发症的风险。一种简单而准确的血液检测方法，能够在孕早期识别出GDM低风险或高风险的女性，有可能通过预防或治疗降低成本并改善结局。本综述总结了已发表的关于作为GDM预测指标进行检测的孕早期生物标志物的数据。
已经报道了大量GDM的孕早期生化预测指标，大多来自小型病例对照研究。这些指标包括血糖标志物（空腹血糖、负荷后血糖、糖化血红蛋白A1C）、炎症标志物（C反应蛋白、肿瘤坏死因子-α）、胰岛素抵抗标志物（空腹胰岛素、性激素结合球蛋白）、脂肪细胞衍生标志物（脂联素、瘦素）、胎盘衍生标志物（类卵泡抑素-3、胎盘生长因子、胎盘外泌体）以及其他指标（如糖基化纤维连接蛋白、可溶性（原）肾素受体、丙氨酸转氨酶、铁蛋白）。一些大型研究表明，孕早期空腹血糖或糖化血红蛋白A1C可能有助于识别那些将从早期GDM治疗中获益的女性。为了将孕早期GDM生物标志物的观察性研究结果转化为临床实践，需要基于这些新型生物标志物的筛查和治疗策略的试验或成本效益分析。
