Amino Acids Levels In Early Pregnancy And The Risk Of Gestational Diabetes

Background:Gestational diabetes mellitus(GDM)refers to diabetes that was first discovered or diagnosed during pregnancy.Early intervention could remarkably reduce the risk of developing gestational diabetes mellitus(GDM).However,the current risk factor screen is still mainly depended on conventional risk factors,such as age and parity.Since the traditional model is not satisfactory,it is important to find and establish an effective and accurate prediction model.Advantages of metabolomics in exploring possible biomarkers of diseases have been demonstrated recently.Also,early studies regarding the prediction ability of amino acids levels in early pregnancy for future GDM were not in consistency.Methods:The prospective cohort study enrolled 431 women,who were receiving prenatal care around 12-16 weeks of gestation at the Department of Obstetrics and Gynecology of Second Affiliated Hospital of Soochow University from August 2015 to January 2016.High performance liquid chromatography electrospray tandem mass spectrometry was used to measure amino acids levels in early pregnancy.All participants were followed up until delivery.At 24-28 weeks of gestation,all participants were administered a 75 g oral glucose tolerance test for the diagnosis of GDM.Results:Concentrations of alanine,isoleucine and tyrosine in early pregnancy were found to be significantly different between women who developed GDM and those who remained normal glucose tolerant(NGR).After adjustments for conventional risk factors,alanine,isoleucine and tyrosine levels in early pregnancy were independently associated with subsequent GDM.The addition of isoleucine and tyrosine into the model including conventional risk factors marginally improved area under curve(AUC)from 0.692 to 0.737(P=0.036);however,significantly increase the net reclassification improvement(NRI,+13.7%,P=0.0025).Conclusions:The present study suggested that elevated isoleucine,tyrosine and alanine levels were independently and significantly associated with subsequent incidence of GDM.After incorporating isoleucine and tyrosine into the conventional model modestly increase the discrimination ability and significantly improve the reclassification ability of the new model.