Centre de Toxicologie du Québec, Institut national de santé publique du Québec (INSPQ), 945 Wolfe, Québec, QC G1V 5B3, Canada; Axe santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec, Hôpital du Saint-Sacrement, 1050, chemin Sainte-Foy, Québec, QC G1S 4L8, Canada.
Centre de Toxicologie du Québec, Institut national de santé publique du Québec (INSPQ), 945 Wolfe, Québec, QC G1V 5B3, Canada.
Diabetes Res Clin Pract. 2018 Jun;140:183-190. doi: 10.1016/j.diabres.2018.03.058. Epub 2018 Apr 4.
Gestational diabetes mellitus (GDM) affects between 5 and 10% of all pregnancies in Canada and can lead to adverse health outcomes in both the mother and fetus. Amino acids (AA) and acylcarnitines (AC) have been identified as early biomarkers of type 2 diabetes but their usefulness in screening for GDM has yet to be demonstrated.
We conducted a nested case-control study involving 50 controls and 50 GDM cases diagnosed between the 24th and 28th week of gestation. Heparinized plasma samples were obtained during the first and early second trimester of pregnancy. Case and controls were matched according to date of recruitment, maternal age, gestational age at blood sampling as well as pre-pregnancy body mass index. Eight AA and eight AC were quantified using an ultra-high pressure liquid-chromatography quadrupole time-of-flight mass spectrometry platform. Conditional regression analyses adjusted for matching factors and smoking habits during pregnancy were performed to identify plasma metabolites associated with GDM risk.
Odds ratio (OR) and 95% confidence interval (CI) for the prediction of GDM per one standard deviation increase of AA or AC in plasma levels were 0.25 (0.08-0.79) for butyrylcarnitine, 0.31 (0.12-0.79) for glutamic acid, 2.5 (1.2-5.3) for acetylcarnitine, 2.9 (1.3-6.8) for isobutyrylcarnitine and 5.3 (1.7-17.0) for leucine. These five metabolites were selected by stepwise conditional logistic regression to create a predictive model with an OR of 2.7 (1.5-4.9).
Whether the identified metabolites can predict the risk of developing GDM requires additional studies in a larger sample of pregnant women.
妊娠糖尿病（GDM）影响加拿大所有妊娠的 5%至 10%，并可能导致母婴健康不良后果。已经确定氨基酸（AA）和酰基辅酶 A（AC）是 2 型糖尿病的早期生物标志物，但它们在 GDM 筛查中的有用性尚未得到证实。
我们进行了一项巢式病例对照研究，涉及 50 名对照和 50 名在妊娠 24 至 28 周之间诊断的 GDM 病例。在妊娠的第一和早期第二阶段采集肝素化血浆样本。病例和对照根据招募日期、采血时的母亲年龄、孕龄以及孕前体重指数进行匹配。使用超高压液相色谱四极杆飞行时间质谱平台定量分析 8 种 AA 和 8 种 AC。进行条件回归分析，调整匹配因素和怀孕期间的吸烟习惯，以确定与 GDM 风险相关的血浆代谢物。
AA 或 AC 血浆水平每增加一个标准差，GDM 的预测比值比（OR）和 95%置信区间（CI）分别为：丁酰基辅酶 A 0.25（0.08-0.79）、谷氨酸 0.31（0.12-0.79）、乙酰基辅酶 A 2.5（1.2-5.3）、异丁酰基辅酶 A 2.9（1.3-6.8）和亮氨酸 5.3（1.7-17.0）。这五种代谢物通过逐步条件逻辑回归选择，创建了一个 OR 为 2.7（1.5-4.9）的预测模型。
所确定的代谢物是否可以预测发展为 GDM 的风险，需要在更大的孕妇样本中进行进一步研究。
