ORIGINAL RESEARCH

Obstetrics and Gynecology

doi: 10.25005/2074-0581-2024-26-4-548-555
HIGH-SENSITIVITY C-REACTIVE PROTEIN IN THE FIRST TRIMESTER OF PREGNANCY IN OBESE PATIENTS WITH GESTATIONAL DIABETES

S.R. BELOMESTNOV1,2, T.V. CHUMARNAYA3, O.YU. SEVOSTYANOVA1, A.M. KSENOFONTOV2, T.M. ISAKOVA1, E.D. PRAZDNICHKOVA1

1Ural State Medical University, Ekaterinburg, Russian Federation
2Ekaterinburg Clinical Perinatal Center, Ekaterinburg, Russian Federation
3Laboratory for Mathematical Physiology, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, Russian Federation

Objective: To determine the prognostic value of high-sensitivity C-reactive protein (hsCRP) levels in the first trimester for the risk of gestational diabetes mellitus (GDM) in obese pregnant women.

Methods: A prospective observational descriptive cohort study included 105 obese women with a body mass index (BMI) ranging from 25.0 to 29.99 kg/m² in the first trimester. The main group consisted of 31 pregnant patients with GDM. The control group included 74 pregnant women without carbohydrate metabolism disorders. BMI and hsCRP concentration in venous blood serum were determined for each woman. All laboratory measurements were performed simultaneously in the same laboratory by the same specialist. The median, 1st, and 3rd quartiles were used to describe the central tendency. The diagnostic value of the parameters (GDM prognosis) was assessed using the area (AUC) under the characteristic receiver operating curve (ROC). Differences were considered statistically significant if p<0.05.

Results: A statistically significant increase in the hsCRP concentration was found: 2.5 [0.4; 5.35] mg/l in the main group compared to the 0.4 [0.4; 0.4] mg/l in the control group (p<0.001). The value of hsCRP for GDM prognosis was confirmed: AUC=0.77 (p<0.001), and the cut-off threshold was 0.5 g/ ml (sensitivity=68%, specificity=85%).

Conclusion: The study's findings suggest that an hsCRP concentration above 0.5 mg/l could be a valuable screening tool for obese pregnant women with normal glycemic levels in the first trimester. This marker could serve as an additional prognostic criterion for GDM, equipping healthcare professionals with a powerful tool for early risk identification.

Keywords: Gestational diabetes mellitus, obesity, C-reactive protein, metabolic maladaptation, pregnancy complications.

Download file:


References
  1. Paulo MS, Abdo NM, Bettencourt-Silva R, Al-Rifai RH. Gestational diabetes mel litus in Europe: A systematic review and meta-analysis of prevalence studies. Front Endocrinol (Lausanne). 2021;9(12):1-20. https://doi.org/10.3389/fen do.2021.691033
  2. Dłuski DF, Ruszała M, Rudziński G, Pożarowska K, Brzuszkiewicz K, Leszczyńs ka-Gorzelak B. Evolution of gestational diabetes mellitus across continents in 21st century. Int J Environ Res Public Health. 2022;19(23):1-32. https://doi. org/10.3390/ijerph192315804
  3. Abramova ME, Khodzhaeva ZS, Gorina KA, Muminova KT, Goryunov KV, Rago zin AK, i dr. Gestatsonnyy sakharnyy diabet: skrining i diagnosticheskie kriterii v rannie sroki beremennosti [Gestational diabetes mellitus: Screening and di agnostic criteria in early pregnancy]. Akusherstvo i ginekologiya. 2021;5:25-32. https://doi.org/10.18565/aig.2021.5.25-32
  4. Sweeting A, Wong J, Murphy HR, Ross GP. A clinical update on gestational diabetes mellitus. Endocr Rev. 2022;43(5):763-93. https://doi.org/10.1210/ endrev/bnac003
  5. Kawai T, Autieri MV, Scalia R. Adipose tissue inflammation and metabolic dys function in obesity. Am J Physiol Cell Physiol. 2021;320(3):C375-C391. https:// doi.org/10.1152/ajpcell.00379.2020
  6. Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and meta bolic disease. J Clin Invest. 2017;127(1):1-4. https://doi.org/10.1172/JCI92035
  7. Hotamisligil GS. Inflammation, metaflammation and immunometabolic disor ders. Nature. 2017;542(7640):177-85. https://doi.org/10.1038/nature21363
  8. Hotamisligil GS. Foundations of immunometabolism and implications for metabolic health and disease. Immunity. 2017;47(3):406-20. https://doi. org/10.1016/j.immuni.2017.08.009
  9. Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:1-11. https://doi.org/10.3389/fim mu.2018.00754
  10. Stanimirovic J, Radovanovic J, Banjac K, Obradovic M, Essack M, Zafirovic S, et al. Role of C-reactive protein in diabetic inflammation. Mediators Inflamm. 2022;1:1-15. https://doi.org/10.1155/2022/3706508
  11. Mouliou DS. C-reactive protein: Pathophysiology, diagnosis, false test results and a novel diagnostic algorithm for clinicians. Diseases. 2023;11(4):132. https://doi.org/10.3390/diseases11040132
  12. Petelina TI, Musikhina NA, Gapon LI, Sharoyan YuA, Gorbatenko EA, Zueva EV. Sravnitel'nyy analiz dannykh prospektivnogo issledovaniya biokhimicheski kh parametrov syvorotki krovi u bol'nykh ishemicheskoy bolezn'yu serdtsa s nalichiem i otsutstviem sakharnogo diabeta 2 tipa [Comparative analysis of prospective study data of biochemical parameters of blood serum in patients with ischemic heart disease with the presence and absence of type 2 diabetes]. Ural'skiy meditsinskiy zhurnal. 2018;7(162):72-8. https://doi.org/10.25694/ URMJ.2018.04.128
  13. Vecchié A, Bonaventura A, Carbone F, Maggi D, Ferraiolo A, Carloni B, et al. C-reactive protein levels at the midpregnancy can predict gestational complica t ions. Biomed Res Int. 2018;7:107-51. https://doi.org/10.1155/2018/1070151
  14. Alyas S, Roohi N, Ashraf S, Ilyas S, Ilyas A. Early pregnancy biochemical markers of placentation for screening of gestational diabetes mellitus (GDM). Diabetes Metab Syndr. 2019;13(4):2353-6. https://doi.org/10.1016/j.dsx.2019.06.006
  15. Liu Y, Li DY, Bolatai A, Wu N. Progress in research on biomarkers of gesta t ional diabetes mellitus and preeclampsia. Diabetes Metab Syndr Obes. 2023;16:3807-15. https://doi.org/10.2147/DMSO.S433179
  16. Alamolhoda SH, Yazdkhasti M, Namdari M, Zakariayi SJ, Mirabi P. Association between C-reactive protein and gestational diabetes: A prospective study. J Obstet Gynaecol. 2020;40(3):349-53. https://doi.org/10.1080/01443615.201 9.1631767
  17. Guidelines for perinatal care. Washington: American Academy of Pediatrics, 2017: 712. https://doi.org/10.1542/9781610020886
  18. Dedov II, Shestakova MV, Melnichenko GA, Mazurina NV, Andreeva EN, Bond arenko IZ, i dr. Mezhdunarodnye klinicheskie rekomendatsii «Lechenie ozhire niya i komorbidnykh zabolevaniy» [Interdisciplinary clinical practice guidelines "Management of obesity and its comorbidities"]. Ozhirenie i metabolizm. 2021;18(1):5-99. https://doi.org/10.14341/omet12714
  19. Nehring SM, Goyal A, Patel BC. C reactive protein. In: Stat Pearls Publishing, 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441843.
  20. Sokolovskaya TA, Stupak VS. Zabolevaemost' beremennykh zhenshchin v Ros siyskoy Federatsii: tendentsii i prognozy [Morbidity of pregnant women in the Russian Federation: Trends and prognosis]. Rossiyskiy vestnik akushera-gine kologa. 2022;22(5):7-14. https://doi.org/10.17116/rosakush2022220517
  21. Normal’naya beremennost’ (klinicheskie rekomendatsii) [Normal pregnancy (clinical guidelines)]. Akusherstvo i ginekologiya. Novosti. Mneniya. Obuchenie. 2020;8(4):48-78.
  22. Ozgu-Erdinc AS, Yilmaz S, Yeral MI, Seckin KD, Erkaya S, Danisman AN. Predic t ion of gestational diabetes mellitus in the first trimester: Comparison of C-re active protein, fasting plasma glucose, insulin and insulin sensitivity indices. J Matern Fetal Neonatal Med. 2015;28(16):1957-62. https://doi.org/10.3109/1 4767058.2014.973397
  23. Savvidou M, Nelson SM, Makgoba M, Messow CM, Sattar N, Nicolaides K. First-trimester prediction of gestational diabetes mellitus: Examining the po tential of combining maternal characteristics and laboratory measures. Diabe tes. 2010;59(12):3017-22. https://doi.org/10.2337/db10-0688
  24. Amirian A, Rahnemaei FA, Abdi F. Role of C-reactive protein (CRP) or high-sensitivity CRP in predicting gestational diabetes mellitus: Systematic review. Diabetes Metab Syndr. 2020;14(3):229-36. https://doi.org/10.1016/j. dsx.2020.02.004
  25. Bogaardt L, Van Giessen A, Picavet HSJ, Boshuizen HC. A model of individu al bmi trajectories. Math Med Biol. 2024;2:1-19. https://doi.org/10.1093/ imammb/dqad009

Authors' information:


Belomestnov Sergey Razumovich,
Candidate of Medical Sciences, Associate Professor at the Department of Obstetrics and Gynecology, Ural State Medical University; Obstetrician-Gynecologist, Ekaterinburg Clinical Perinatal Center
ORCID ID: 0000-0002-4031-4907
E-mail: beldoctor@mail.ru

Сhumarnaya Tatyana Vladislavovna,
Candidate of Biological Sciences, Senior Researcher, Laboratory for Mathematical Physiology, Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences
ORCID ID: 0000-0002-7965-2364
E-mail: chumarnaya@gmail.com

Sevostyanova Olga Yurievna,
Doctor of Medical Sciences, Professor at the De partment of Obstetrics and Gynecology, Ural State Medical University
ORCID ID: 0000-0002-0828-0479
E-mail: olsyava@gmail.com

Ksenofontov Aleksey Mikhaylovich,
Obstetrician-Gynecologist, Ekaterinburg Clinical Perinatal Center
ORCID ID: 0009-0009-3432-9334
E-mail: mail@ekpc-info.ru

Isakova Tatyana Mikhaylovna,
Candidate of Medical Sciences, Associate Pro fessor at the Department of Oncology and Radiation Diagnostics, Ural State Medical University
ORCID ID: 0000-0003-0050-9301
E-mail: beldoctor@mail.ru

Prazdnichkova Ekaterina Dmitrievna,
Student, Ural State Medical University
ORCID ID: 0009-0003-8907-3619
E-mail: beldoctor@mail.ru

Information about support in the form of grants, equipment, medications

The work was carried out within the framework of the state assignment of the Institute of Immunology and Physiology of the Ural Branch of the Russian Academy of Sciences (No. 122022200089-4). The authors did not receive fi nancial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:


Belomestnov Sergey Razumovich
Candidate of Medical Sciences, Associate Professor at the Department of Ob stetrics and Gynecology, Ural State Medical University; Obstetrician-Gynecolo gist, Ekaterinburg Clinical Perinatal Center

620086, Russian Federation, Ekaterinburg, Moskovskaya str., 66

Tel.: +7 (912) 2870603

E-mail: beldoctor@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

Materials on the topic: