Lower ATG7 Levels are Associated with a Higher Risk of Gestational Diabetes Mellitus: A Cross-Sectional Study

Figures & data

Figure 1 Flow chart of the study design.

Table 1 Clinical and Laboratory Characteristics Between the GDM Group and Non-GDM Group

Parameters	GDM Group (n=83)	Non-GDM Group (n=649)	p-value
Maternal age (years)	28±3.23	29±3.58	0.131
Gestational age (weeks)	31.47±4.35	30.52±4.78	0.182
Prepregnancy BMI (kg/m^2)	24.34±3.21	22.57±3.53	0.031
Parity			0.426
Primiparous	44	314
Multiparous	39	335
Fasting glucose (mmol/L)	5.15±1.38	4.16±0.71	0.024
1 h-glucose (mmol/L)	9.94±1.72	7.26±1.94	0.012
2 h-glucose (mmol/L)	8.54±1.58	6.31±1.36	0.001
HbA1c (%)	6.51±1.12	5.12±1.08	0.032
HOMA-β	216.31±15.23	235.1±16.78	<0.001
HOMA-IR	2.58±0.891	1.85±0.613	<0.001
TC (mmol/L)	5.85±1.43	4.15±1.18	0.023
TG (mmol/L)	3.79±1.41	3.03±1.14	0.021
LDL-C (mmol/L)	3.78±0.85	2.83±0.51	0.038
HDL-C (mmol/L)	1.33±0.42	2.15±0.71	0.032
Plasma ATG7 levels (ng/mL)	15.78±3.26	45.21±6.17	<0.001

Note: Data are evaluated by independent samples t-test or Chi-square test, a p-value <0.05 is considered statistical significance.

Abbreviations: HbA1c, glycated hemoglobin; HOMA-β, homeostasis model assessment of insulin secretion; HOMA-IR, homeostasis model assessment of insulin resistance; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; BMI, body mass index.

Table 2 Correlations of ATG7 Levels with Lipid Profiles and Glycemic Indices in the GDM Group

Variables	Plasma ATG7 Levels
	r	p-value
Fasting glucose (mmol/L)	−0.32	0.023
1h-glucose (mmol/L)	−0.53	<0.001
2h-glucose (mmol/L)	−0.41	0.010
HbA1c (%)	−0.28	0.121
HOMA-β	0.47	0.014
HOMA-IR	−0.58	0.012
TC (mmol/L)	−0.23	0.261
TG (mmol/L)	−0.43	<0.001
LDL-C (mmol/L)	−0.32	0.011
HDL-C (mmol/L)	0.51	0.314

Note: Data are evaluated by Pearson correlation analysis and a p-value <0.05 is considered statistical significance.

Abbreviations: HbA1c, glycated hemoglobin; HOMA-β, homeostasis model assessment of insulin secretion; HOMA-IR, homeostasis model assessment of insulin resistance; TC, total cholesterol; TG, triglycerides; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol.

Table 3 Associations Between ATG7 Levels and Risk of GDM Assessed by Logistic Regression Models

GDM	Plasma ATG7 Levels (ng/mL)			P-value
	T1 (12.52–25.47) OR (95% CI)	T2 (25.65–38.78) OR (95% CI)	T3 (38.83–51.38) OR (95% CI)
Crude model	5.63 (3.25–9.05)	4.73 (2.27–8.74)	1.00 (reference)	0.001
Model 1	5.43 (3.04–8.61)	4.42 (2.21–8.25)	1.00 (reference)	0.003
Model 2	5.13 (2.93–8.32)	4.21 (2.03–7.26)	1.00 (reference)	0.013
Model 3	2.12 (1.02–6.14)	1.62 (0.56–6.37)	1.00 (reference)	0.027

Notes: Data are presented as odds ratio (95% confidence interval) compared with tertile 3. Data are evaluated by a logistic regression model, a p-value <0.05 is considered statistical significance. The crude model is unadjusted. Model 1 is adjusted for gravidity, parity, gestational age, family history of diabetes, prepregnancy BMI, and the levels of TC, TG, HbA1c, HDL-C, and LDL-C. Model 2 is adjusted for Model 1 plus HOMA-β. Model 3 is adjusted for Model 2 plus HOMA-IR.

Abbreviations: OR, odds ratio; CI, confidence interval; GDM, gestational diabetes mellitus; T, tertile.

Figure 2 Prevalence of GDM at each tertile of plasma ATG7 levels.

Table 4 Association Between ATG7 Levels and Insulin Resistance

HOMA-IR	Plasma ATG7 Levels
	β	SE	p-value
Crude model	−0.53	0.13	<0.001
Model 1	−0.45	0.07	0.003
Model 2	−0.41	0.04	0.021

Notes: Data were analyzed by multiple linear regression, and a p-value <0.05 is considered statistical significance. The crude model is unadjusted. Model 1 is adjusted for gravidity, parity, levels of TC, TG, HbA1c, HDL-C and LDL-C, gestational age, family history of diabetes, and pre-pregnancy BMI. Model 2 is adjusted for Model 1 plus HOMA-β.

Abbreviations: HOMA-IR, homeostasis model assessment of insulin resistance; β, β coefficient; SE, standard errors.