Visfatin level and gestational diabetes mellitus: a systematic review and meta-analysis

Figures & data

Figure 1. Flow diagram of study recruiting.

Table 1. Characteristics of studies included in the meta-analysis.

Study	Country	GDM criteria	Sample	Methods	Case group		Control group		Measurement trimester	Average age	Average BMI (kg/m²)
					Sample size	Visfatin	Sample size	Visfatin
Abell et al. (2017)	Australia	ADIPS	Serum	ELISA	25	0.12 ± 0.09	78	0.13 ± 0.1	First	32.7	28
Akturk et al. (2008)	Turkey	ADA	Plasma	EIA	47	75.3 ± 4.9	31	110.8 ± 7.8	Third	30.1	29.2
Boyadzhieva et al. (2013)	Bulgaria	IADPSG	Serum	EIA	127	462.5 ± 50.2	109	448.5 ± 48.9	Second	32.2	28.5
Chan et al. (2006)	China	NDDG	Plasma	ELISA	20	9.4 ± 3.8	20	12.6 ± 4.5	Second	32.7	26.1
Coskun et al. (2010)	Turkey	C&C	Plasma	ELISA	21	23.15 ± 19.32	24	8.37 ± 5.8	Second	30	29.32
Ferreira et al. (2011)	UK	WHO	Serum	ELISA	100	1.2 ± 1.42	300	0.89 ± 0.92	First	33.8	28.4
Gok et al. (2011)	Turkey	4th WCGD	Plasma	EIA	23	7.15 ± 1.1	22	5.71 ± 1.6	Second	30.9	24.5
Gorkem et al. (2016)	Turkey	C&C	Serum	ELISA	76	0.07 ± 0.06	82	0.07 ± 0.07	Second	29	33.25
Haider et al. (2007)	Australia	IADPSG	Plasma	ELISA	10	1.9 ± 0.8	10	5.2 ± 4.4	Second	33	NR
Hossein-Nezhad et al. (2010)	Iran	ADA	Serum	ELISA	70	10.62 ± 8.12	76	4.3 ± 4	Second	32	28.2
Karatas et al. (2014)	Turkey	C&C	Serum	ELISA	40	8.58 ± 2.84	40	8.64 ± 2.8	Second	30.1	29.9
Kaygusuz et al. (2013)	Turkey	NDDG	Serum	ELISA	30	564.7 ± 161.22	28	371.03 ± 163.8	Second	30.8	29.1
Krzyzanowska et al. (2006)	Austria	4th WCGD	Serum	EIA	64	64 ± 17.7	30	46 ± 13.11	Third	32	29.4
Lewandowski et al. (2007)	Poland	WHO	Serum	ELISA	16	93.1 ± 12.3	20	76.8 ± 14.1	Second	33	28
Liang et al. (2016)	China	ADA	Serum	ELISA	38	189.4 ± 77.3	35	117.9 ± 44.3	Second	28	32.1
Ma et al. (2010)	China	ADA	Serum	ELISA	20	7.9 ± 2	22	6.2 ± 1.4	Third	28.9	30.1
Maitland et al. (2014)	UK	IADPSG	Plasma	ELISA	29	4.94 ± 1.4	77	5.28 ± 1.42	First	34	35.27
Noureldeen et al. (2014)	Saudi Arabia	WHO	Serum	ELISA	24	6.66 ± 0.426	33	5.56 ± 0.331	Second	36.38	31.1
Noureldeen et al. (2014)	Saudi Arabia	WHO	Serum	ELISA	47	9.01 ± 0.405	38	8.38 ± 0.517	Third	33.51	30.08
Oncul et al. (2013)	Turkey	C&C	Plasma	ELISA	24	0.68 ± 0.06	21	1.18 ± 1.65	Third	34	31.32
Rezvan et al. (2012)	Iran	C&C	Serum	ELISA	35	5.29 ± 0.47	35	7.76 ± 0.53	Second	30.86	29.61
Skvarca et al. (2012)	Slovenia	IADPSG	Serum	ELISA	30	2.99 ± 2.87	25	3.5 ± 3.11	Second	30.33	27.57
Souvannavong-Vilivong et al. (2019)	Thailand	C&C	Serum	EIA	37	10.1 ± 8.81	37	4.95 ± 3.59	Third	32.1	29
Szamatowicz et al. (2009)	Poland	WHO	Serum	EIA	61	14.8 ± 4.81	63	15.3 ± 5.63	Third	30	26.6
Telejko et al. (2009)	Poland	WHO	Serum	EIA	23	14.8 ± 7.78	23	15.4 ± 4.07	Third	30	26.8
Telejko et al. (2009)	Poland	WHO	Serum	ELISA	23	1.35 ± 1.28	23	1.14 ± 0.74	Third	30	26.8

GDM: gestational diabetes mellitus; BMI: body mass index; ADIPS: Australasian Diabetes in Pregnancy Society; IADPSG: International Association of Diabetes and Pregnancy study groups; NDDG: National Diabetes Data Group; 4th WCGD: the 4th Workshop Conference of Gestational Diabetes; C&C: Carpenter and Coustan; WHO: World Health Organisation; ADA: American Diabetes Association; ELISA: enzyme-linked immunosorbent assay; EIA: enzyme immune assay; NR: not reported.

Figure 2. Risk of bias graph. The Cochrane collaboration’s tool was used to evaluate risk of bias.

Figure 3. Forest plot of circulating visfatin level in GDM or healthy pregnant women. The random effect model (Inverse Variance method) was applied.

Figure 4. Begg’s funnel plot of included studies for potential publication bias.

Figure 5. Sensitivity analysis of the circulating visfatin levels in GDM or healthy pregnant women.

Figure 6. Subgroup analysis of visfatin levels in GDM or healthy pregnant women based on average BMI. The random effect model (Inverse Variance method) was applied.

Figure 7. Subgroup analysis of visfatin levels in GDM or healthy pregnant women based on measurement trimester. The random effect model (Inverse Variance method) was applied.

Table 2. Subgroup meta-analysis of the included studies.

Stratification	Study number	SMD	95% CI	p Value^a	Heterogeneity
					Tau²	Chi²	p Value^b	I²
Geographic site
Asian	12	0.31	[−0.37, 0.99]	.37	1.47	250.42	<.001	95%
Caucasian	12	−0.10	[−0.55, 0.34]	.65	0.59	169.18	<.001	93%
Measurement trimester
First	3	0.02	[−0.33, 0.38]	.89	0.06	5.77	.06	65%
Second	14	0.25	[−0.31, 0.81]	.38	1.04	233.91	<.001	94%
Third	8	−0.15	[−0.98, 0.69]	.73	1.56	182.07	<.001	96%
Average age
<30 years	3	0.67	[−0.13, 1.47]	.1	0.44	17.28	.0002	88%
≥30 years	21	0.01	[−0.41, 0.44]	.95	0.99	408.8	<.001	95%
Average BMI
<30 kg/m²	18	−0.12	[−0.59, 0.35]	.62	0.95	325.47	<.001	95%
≥30 kg/m²	7	0.14	[0.06, 1.49]	.03	0.86	89.03	<.001	93%
Sample
Plasma	7	−0.81	[−2.01, 0.39]	.18	2.5	145.97	<.001	96%
Serum	17	0.40	[0.03, 0.77]	.03	0.61	250.77	<.001	93%
Methods
ELISA	18	0.23	[−0.20, 0.66]	.29	0.82	268.28	<.001	93%
EIA	7	−0.29	[−1.16, 0.59]	.53	1.33	157.64	<.001	96%

^ap Values in subgroups.

^bp Values for Cochran’s Q statistic test used to assess the heterogeneity.

BMI: body mass index; ELISA: enzyme-linked immunosorbent assay; EIA: enzyme immune assay; CI: confidential interval; SMD: standard mean difference.

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Data availability statement

The data that support the findings of this study are available on request from the corresponding author, FX Gong. The data are not publicly available due to the containing information that could compromise the privacy of research participants.