Relationship between C-reactive protein and proinflammatory markers in pregnant women with gestational diabetes mellitus – a case-control study
General Medicine,2023, 25(1), 25-31.
M. Genova1, K. Todorova2
1 Department of Clinical Laboratory, UMHAT “Alexandrovska”, Medical University ‒ Sofia
2 Clinic of Endocrinology, UMHAT „Dr Georgi Stranski“, Medical University ‒ Pleven
Abstract. Background: C-reactive protein (CRP) is an acute-phase protein, which increases during pregnancy. It could be a promising biomarker of gestational diabetes mellitus (GDM). The aim of this study was to investigate the role of CRP as a risk factor for development of GDM in late second trimester and its connection to some inflammatory markers. Material and methods: Total of 123 pregnant women (aged 18- 40, second trimester) were included in the study and divided into two groups (pregnant women with GDM, n= 54; pregnant women with normal glucose tolerance (NGT), n = 69) after performing a 2 h 75 g oral glucose tolerance test (OGTT). Maternal blood samples were collected during late second trimester. Information of maternal social demographic characteristics was collected using questionnaires. Blood glucose was measured by amperometric method (Biosen C-line); CRP and ceruloplasmin (CP) were measured by immunoturbidimetric assay (Cobas Integra 400 Plus, Roche); serum levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA). Body Mass Index (BMI) was calculated as follows: weight/height2 (kg/m2). All data are analyzed using IBM Statistical Package for Social Science (SPSS) software for Windows version 23. P < 0.05 was considered statistically significant. Results: In comparison to controls, pregnant women with GDM showed a significant difference in the serum CRP levels (р = 0.002); TNF-α and IL-6 (p < 0.001); higher level of BMI before pregnancy and during the GDM diagnosis; higher levels of glucose during OGTT (p < 0.001). Positive correlations were found between CRP and TNF-α, IL-6 (p < 0.001); CP (р = 0, 04) and BMI with the GDM diagnosis (p < 0,01) in GDM group. Similar results were presented in the NGT group, but only for association between CRP and CP (р = 0,009), IL-6 (p < 0,000); BMI before (p < 0.01) and during pregnancy (p = 0.002). No connection was found between CRP and glucose levels during OGTT in pregnant women. Our study showed that CRP is a risk factor for development of GDM during the second trimester of pregnancy; OR = 1.144 (95%CI: 1.028-1.273; p < 0.01). Each increase in CRP value by 1 mg/L increases the risk of developing GD by 14.4%. Conclusions: Our study found that CRP is a risk factor for development of GDM in the late second trimester. During this period of pregnancy other pro-inflammatory markers such as CP, TNF-α and IL-6 are significantly increased, which shows a positive relationship with CRP. These results suggest an involvement of maternal inflammatory markers in developing GDM in late second trimester, where CRP could play a significant role. Additional studies are needed to investigate the exact roles of these factors during childbirth.
Key words: gestational diabetes mellitus, C-reactive protein, TNF-α, IL-6, ceruloplasmin
Address for correspondence: Assoc. Prof. Mariana Genova, MD, PhD, е-mail: mgenova@medfac.mu-sofia.bg