First trimester screening for gestational diabetes mellitus by maternal factors and markers of inflammation.

OBJECTIVE To examine the potential role of maternal serum levels of tumor necrosis factor-α (TNF-α) and high sensitivity C-reactive protein (Hs-CRP) in the first trimester of pregnancy in the prediction of gestational diabetes mellitus (GDM). METHODS Maternal serum TNF-α and Hs-CRP concentrations were measured in a case-control study of singleton pregnancies at 11-13 weeks' gestation, which included 200 cases that subsequently developed GDM and 800 unaffected controls. Measured levels of TNF-α and Hs-CRP were expressed as multiples of the median (MoM) after adjustment for maternal characteristics and history. The performance of screening for GDM by maternal factors and MoM values of TNF-α and Hs-CRP was evaluated by the area under the receiver operating characteristic curves (AUROC). RESULTS In the GDM group, compared to the normal group, the median TNF-α was significantly increased (1.303 MoM, interquartile range [IQR] 1.151-1.475 vs. 1.0 MoM, IQR 0.940-1.064; p=0.031) and the median Hs-CRP was not significantly different (1.113 MoM, IQR 0.990-1.250 vs. 1.0 MoM, IQR 0.943-1.060; p=0.084). In the prediction of GDM, the AUROC for maternal characteristics with TNF-α or Hs-CRP was not significantly different than the AUROC for maternal characteristics alone (p=0.5055 and p=0.2197, respectively). CONCLUSIONS In pregnancies that develop GDM there is no evidence of an inflammatory response at 11-13 weeks' gestation and the levels of serum TNF-α and Hs-CRP are not useful in first-trimester screening for GDM.