Abstract:

Objective To investigate the predictive role of serum amyloid A（SAA） and homocysteine（Hcy） in adverse pregnancy outcomes of patients with gestational diabetes mellitus（GDM）. Methods A total of 80 GDM patients（GDM group） from Anji County Maternal and Child Health Hospital from January 2022 to January 2023 were enrolled，and 80 pregnant women with normal glucose tolerance were enrolled as control group. The general information was collected，and the levels of glycated hemoglobin A_1c（HbA_1c），blood glucose，blood lipid，SAA and Hcy were determined at 24-28 weeks of pregnancy. The levels of serum nitric oxide（NO），endothelin-1（ET-1），interleukin-6（IL-6） and tumor necrosis factor-alpha（TNF-α） were determined. All the subjects were followed up until the pregnancy outcome. Logistic regression analysis was used to analyze the influencing factors of adverse pregnancy outcomes in GDM patients. Receiver operating characteristic（ROC） curve was used to evaluate the efficacy of each indicator in judging the adverse pregnancy outcomes of GDM patients. Results The proportions of history of alcohol consumption，multiparity and family history of diabetes in GDM group were higher than those in control group（P<0.05），and the levels of HbA_1c，fasting blood glucose（FBG），1 h postprandial blood glucose（PG），2 h PG，SAA and Hcy were higher in GDM group（P<0.05）. There was no statistical significance in ages，gestational weeks，pre-pregnancy body mass index（BMI），blood pressure and bood lipid indicators between the 2 groups（P>0.05）. The incidence of adverse pregnancy outcomes in GDM group（23.75%） was higher than that in control group（11.25%）（P=0.038）. The proportions of multiparity and the levels of SAA，Hcy，NO，ET-1，IL-6，TNF-α in adverse pregnancy group among GDM patients were higher than those in non-adverse pregnancy group（P<0.05）. There was no statistical significance in age，gestational week and pre-pregnancy BMI between the 2 groups（P>0.05）. Elevated Hcy and SAA levels were risk factors for adverse pregnancy outcomes in GDM patients [odds ratios（OR） were 1.735 and 1.233，95% confidence intervals（CI） were 1.223-2.462 and 0.972-1.565，P<0.05]. The areas under curves（AUC） of Hcy，SAA，NO，ET-1，IL-6，TNF-α single determinations and SAA+Hcy combined determination in judging the adverse pregnancy outcomes of GDM patients were 0.812，0.746，0.719，0.706，0.746，0.765 and 0.840，respectively. Conclusions Elevated serum SAA and Hcy levels in GDM patients combinedly have certain clinical value in predicting adverse pregnancy outcomes.

Key words: Serum amyloid A, Homocysteine, Gestational diabetes mellitus, Pregnancy outcome