Low-Grade Inflammation in Gestational Diabetes Mellitus and Its Correlation with Maternal Insulin Resistance and Fetal Growth Indices

Abstract

Introduction

Chronic low-grade inflammation (LGI) plays a role in the pathogenesis of gestational diabetes mellitus (GDM). LGI, on the one hand, promotes insulin resistance and at the same time, affects fetal development. The study aimed to use clinically feasible means to evaluate the association between maternal LGI and maternal insulin resistance and fetal growth indices by ultrasound in the third trimester.

Methods

A crossectional and descriptive study on 248 first-time diagnosed GDM in Vietnam.

Results

Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) indices were significantly higher in GDM than in normal glucose-tolerant pregnancies (p = 0.048 and 0.016, respectively). GDM with LGI witnessed significantly higher systolic blood pressure, BMI, HbA1c, and significantly lower quantitative Insulin Sensitivity Check Index (QUICKI) than those without LGI. After adjusting for maternal BMI, fasting plasma glucose (FPG), age, and parity, C-reactive protein (CRP) was positively correlated with HOMA2-IR (B=0.13, p<0.01) and Mathews index (B=0.29, p<0.01). Regarding fetal characteristics, LGI was associated with fetal growth indices in the third trimester of GDM. NLR was negatively correlated with estimated fetal weight (EFW) (B=−64.4, p<0.05) after adjusting for maternal BMI and FPG. After adjusting for maternal BMI, FPG, age, and parity, PLR was negatively correlated with biparietal diameter (B=−0.02, p<0.01) and abdominal circumference (AC) (B=−0.16, p<0.05), and EFW (B=−1.1, p<0.01), and head circumference (HC) (B=−0.06, p<0.01); CRP was negatively correlated with AC (B=−0.16, p<0.001), EFW (B=−85.3, p<0.001), and HC (B=−5.0, p<0.001).

Conclusion

In the third trimester, LGI was associated with maternal glucose and insulin resistance in GDM. Moreover, LGI was associated with fetal characteristics in ultrasonic images. There were negative correlations between LGI and fetal developmental characteristics.

Keywords:

• gestational diabetes mellitus
• low-grade inflammation
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio
• fetal ultrasound parameters

Abbreviations

GDM, Gestational Diabetes mellitus; LGI, low-grade inflammation; FPG, fasting plasma glucose; PPG, postprandial glucose; OGTT, oral glucose tolerance test; BMI, Body Mass index; G2, 2-hour post OGTT; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; CRP, C-reactive protein; HOMA2-IR, Homeostasis Model Assessment-2-Insulin resistance; QUICKI, Quantitative Insulin Sensitivity Check Index; BPD, Biparietal diameter; HC, Head circumference; AC, Abdominal circumference; FL, Femur length; AFI, Amniotic fluid index; HR, fetal Heart rate; EFW, Estimated fetal weight.

Acknowledgments

We thank the staff in the Outpatients Department of the Vietnam Endocrinology Hospital and Department of Endocrinology and Rheumatology, Military Hospital 103, for collecting the samples and supporting the study.

Author Contributions

Kien Xuan Nguyen and Tien Bui Minh share first authorship. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declared no potential conflicts of interest to this article’s research, authorship, and/or publication.

Additional information

Funding

The author(s) received no financial support for this article’s research, authorship, and/or publication.