First trimester sex hormone-binding globulin predicts gestational diabetes mellitus in a population of Nigerian women

Abstract

There has been a steady rise in the disease burden of Gestational Diabetes Mellitus (GDM) in the sub-Saharan African region over time. Diagnostic testing for GDM is currently recommended at 24 − 28 weeks of gestation, leaving a narrow window for intervention before delivery. Hence the need for early prediction and preventive intervention. The performance of first trimester serum sex hormone-binding globulin (SHBG) assay as a predictor of GDM was determined by binary logistic regression. Women with GDM (n = 49) had a significantly lower mean first trimester SHBG level (104.7 ± 61.6 nmol/L) than did those without GDM (n = 180; 265.2 ± 141.5 nmol/L; p < .001). First trimester SHBG was significantly negatively correlated (r_pb = −0.460, p value = <.001) with subsequent development of GDM and an area under receiver operator characteristics (ROC) curve of 0.874 (p < .001). A cut-off value of 158.0 nmol/L predictive of GDM had a diagnostic sensitivity of 81.5%, a specificity of 80.1%, and an overall diagnostic efficiency of 80.3%.

IMPACT STATEMENT

• What is already known on this subject? GDM is associated with high risk of various complications and is commonly diagnosed at 24–28 weeks of gestation, leaving a narrow window for intervention. The performance of current maternal clinical and demographic risk factor-based prediction approaches is unreliable. Thus, more favourable prediction approaches need to be developed. Previous studies have suggested that SHBG, a readily assessable marker, has potential to predict GDM; however, these studies have mostly involved Caucasian and other non-African populations.

• What the results of this study add? SHBG may serve as a reliable first trimester screening tool for GDM development in Nigerian women with singleton pregnancies. This study demonstrates that first trimester SHBG can predict GDM development in sub-Saharan African women despite racial, ethnic and geographical differences.

• What are the implications of these findings for clinical practice and/or further research? Effective first trimester prediction of GDM using SHBG may enable preventive interventions, thereby mitigating the high burden of the disease in the sub-Saharan African region. It may also provide relevant information that may guide adaptation of current management guidelines to ensure effective management of GDM in the region.

Keywords:

• First trimester
• gestational diabetes
• prediction
• sex hormone-binding globulin (SHBG)
• sub-Saharan Africa

Acknowledgements

The authors acknowledge the managements of Benue State University Teaching Hospital (BSUTH), Federal Medical Center (FMC), Pishon Women Hospital, Family Support Program Clini and First Fertility Hospital for granting us access to patients attending ANC at their centers. The authors also acknowledge Drs. T. Gav and F. Dogoh of Department of Chemical Pathology, Benue State University Teaching Hospital, Makurdi for their assistance in patient preparation and sample collection during recruitment and OGTT.

Authors contributions

This study was a collaborative effort of all listed authors. Author Basil B. conceptualised and designed the study, as well as acquired, analysed and interpretated the data for the work. Authors Oghagbon E. K. and Adebisi S. A. substantially participated in the design of the work and interpretation of data collected while authors Mba I. N. and Agudi C. C. participated in the acquisition and analysis of the data. All listed authors made substantial contributions towards drafting the work and revising it critically for intellectual content, granted final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Data for this study can be made available on request.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.