Gezer Murad, Taşdemir Ümit, Eyisoy Ömer Gökhan, Yiğit Sevdenur, Özdemir Mucize Eriç, Demirci Oya
Department of Perinatology, Zeynep Kâmil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey.
Department of Obstetric and Gynecology, Zeynep Kâmil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey.
Acta Diabetol. 2025 Jun 20. doi: 10.1007/s00592-025-02547-7.
This study aimed to evaluate the FIB-4 and APRI scores in patients with gestational diabetes mellitus (GDM) and investigate their associations with neonatal outcomes. Additionally, the predictive value of these non-invasive fibrosis indices for GDM and adverse perinatal outcomes was assessed.
In this retrospective case-control study, 200 pregnant women diagnosed with GDM and 200 healthy controls were analyzed. Data on maternal demographics, laboratory parameters (ALT, AST, platelet count), FIB-4 and APRI scores, perinatal and neonatal outcomes including fetal growth restriction (FGR), oligohydramnios, polyhydramnios, birth weight, gestational age at birth, neonatal cord blood pH, neonatal hypoglycemia, Apgar 1 min. and 5 min. scores, and neonatal intensive care unit (NICU) admission were collected. Logistic regression analyses were performed to identify independent predictors of adverse perinatal outcomes among GDM patients. ROC analysis was used to determine the diagnostic performance of both indices.
FIB-4 and APRI scores were significantly higher in GDM patients compared to controls (p < 0.05). Among GDM patients, those with FGR, NICU admission, or neonatal death had significantly elevated FIB-4 scores. Stratification by FIB-4 risk categories revealed that patients with high FIB-4 scores had increased rates of FGR, fetal hypoglycemia, adverse perinatal outcomes, and NICU admission (p < 0.01). ROC analysis for predicting GDM yielded AUC values of 0.577 for FIB-4 and 0.571 for APRI. For predicting adverse perinatal outcomes, the FIB-4 AUC was 0.590, while APRI showed limited predictive ability (AUC = 0.511).
FIB-4 can serve as a valuable non-invasive marker for liver dysfunction in GDM and is significantly associated with adverse perinatal outcomes. Despite limited predictive power, these scores may serve as early indicators of hepatic involvement in GDM.
本研究旨在评估妊娠期糖尿病（GDM）患者的FIB-4和APRI评分，并探讨它们与新生儿结局的关联。此外，还评估了这些非侵入性纤维化指标对GDM和不良围产期结局的预测价值。
在这项回顾性病例对照研究中，分析了200例诊断为GDM的孕妇和200例健康对照。收集了产妇人口统计学数据、实验室参数（谷丙转氨酶、谷草转氨酶、血小板计数）、FIB-4和APRI评分、围产期和新生儿结局，包括胎儿生长受限（FGR）、羊水过少、羊水过多、出生体重、出生孕周、新生儿脐血pH值、新生儿低血糖、1分钟和5分钟阿氏评分以及新生儿重症监护病房（NICU）入住情况。进行逻辑回归分析以确定GDM患者不良围产期结局的独立预测因素。采用ROC分析来确定这两个指标的诊断性能。
与对照组相比，GDM患者的FIB-4和APRI评分显著更高（p < 0.05）。在GDM患者中，患有FGR、入住NICU或新生儿死亡的患者FIB-4评分显著升高。按FIB-4风险类别分层显示，FIB-4评分高的患者FGR、胎儿低血糖、不良围产期结局和入住NICU的发生率增加（p < 0.01）。预测GDM的ROC分析中，FIB-4的AUC值为0.577，APRI为0.571。对于预测不良围产期结局，FIB-4的AUC为0.590，而APRI的预测能力有限（AUC = 0.511）。
FIB-4可作为GDM患者肝功能障碍的有价值的非侵入性标志物，且与不良围产期结局显著相关。尽管预测能力有限，但这些评分可作为GDM肝脏受累的早期指标。
