Mean Platelet Volume in the First Trimester as a Predictor of Gestational Diabetes Mellitus
Gestational diabetes mellitus (GDM) is a condition characterized by varying degrees of carbohydrate intolerance during pregnancy. It affects approximately 4% to 25% of pregnant women globally. The majority of GDM patients exhibit varying levels of insulin resistance and chronic low-grade inflammation, which are closely related to vascular injury and dysfunction, subsequently leading to platelet activation. Given this relationship, platelet activation may be closely associated with the severity of GDM. Mean platelet volume (MPV), an index used to evaluate platelet morphology and activity, has been shown to be elevated in conditions such as cardiovascular diseases, hypertension, and nonalcoholic fatty liver disease. However, the relationship between MPV and GDM has not been extensively studied. This study aims to evaluate the diagnostic value of MPV for GDM in the first trimester of pregnancy.
The research was conducted at the Department of Obstetrics and Gynecology in Peking University International Hospital between December 2014 and June 2019. As a retrospective study, it was exempt from ethical approval and informed consent requirements. The study included 1550 women diagnosed with GDM and 2103 healthy pregnant women as controls. Routine blood counts and other necessary tests were performed using venous blood collected during the first prenatal visit after an 8-hour fast. All participants returned for an oral glucose tolerance test (75 g glucose) between 24 and 28 weeks of gestation to confirm the diagnosis of GDM.
Statistical analysis was performed using Python and R. Logistic regression was employed to assess the association between GDM and MPV. Receiver-operating characteristic (ROC) curve analysis was used to determine the MPV cutoff value for predicting GDM in early pregnancy. The MPV frequency histogram for GDM patients was normally distributed, with a 95% confidence interval (CI) of 10.17 to 10.26. Similarly, the MPV frequency histogram for non-GDM cases was normally distributed with a 95% CI of 10.24 to 10.32.
Logistic regression analysis revealed that increasing MPV values were associated with a favorable outcome, specifically non-GDM (odds ratio = 0.92, 95% CI: [0.86–0.99], P = 0.0222). ROC analysis indicated that the MPV cutoff value was 10.25 fL, with a sensitivity of 57.1% and specificity of 47.2%. The area under the curve (AUC) value was 0.522, suggesting that MPV alone is not a strong diagnostic predictor of GDM.
The study concluded that higher MPV values are associated with a lower likelihood of developing GDM. However, the ROC analysis results indicate that MPV alone cannot be used as a definitive diagnostic tool for GDM. Unique endocrinological changes occur throughout pregnancy, with insulin resistance increasing three- to four-fold after 13 weeks. GDM patients are also at higher risk for long-term complications, including type 2 diabetes mellitus and cardiovascular diseases. Additionally, women with a history of GDM have significantly higher rates of obesity, hypertension, and metabolic syndrome.
The relationship between MPV and diabetes severity has been previously reported, although the underlying mechanisms in GDM remain unclear. Insulin resistance may induce platelet activation, which can be assessed through MPV measurement. Key pathophysiological aspects of platelet activation include hyperglycemia, glycemic variability, insulin resistance, and inflammation. Several studies suggest that MPV might be an indicator of chronic inflammatory status in GDM.
Previous studies have yielded inconsistent conclusions regarding the use of MPV as a predictor of GDM in the first trimester. For example, Colak et al. found that MPV could be a useful predictor of GDM in early pregnancy, with a cutoff value of 7.38 fL, sensitivity of 70%, and specificity of 60%. A meta-analysis indicated that MPV was significantly increased in GDM patients during the third trimester, coinciding with the highest levels of insulin resistance. These findings suggest that MPV levels may vary across different trimesters, influenced by insulin resistance and inflammation.
Early diagnosis of pre-pregnancy or gestational diabetes can significantly improve maternal and fetal outcomes. Several studies have explored various predictors of GDM, including increased levels of fasting glucose, hemoglobin A1C, inflammatory markers such as C-reactive protein and tumor necrosis factor-alpha, and novel biomarkers like glycosylated fibronectin and soluble prorenin receptor.
The study has several limitations. First, the number of cases was limited. Second, future studies should include a close follow-up of maternal and fetal outcomes based on MPV values in the third trimester. Third, comparing MPV values across different trimesters would provide more comprehensive insights. Further research is needed to better understand the relationship between MPV and GDM.
Given the adverse complications of GDM for both mothers and their children, there is a need for more scientific research to develop earlier and more accurate diagnostic methods for pre-gestational diabetes mellitus or GDM. This would contribute to improving the health outcomes of women and their children.
The study highlights the potential role of MPV as a marker in the context of GDM but emphasizes that it cannot be used as a standalone diagnostic tool. Further research is essential to explore the underlying mechanisms and to develop more reliable predictors for GDM.
doi.org/10.1097/CM9.0000000000000825
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