Sonographic and Biochemical Markers in Gestational Diabetes Mellitus: A Prospective Cohort Study at a Tertiary Hospital in Greece

Objective The present study investigates biochemical and sonographic markers in pregnant women with gestational diabetes mellitus (GDM), aiming to identify correlations related to demographic factors (maternal age and previous pregnancies), disease severity, and differences among pregnant women with GDM based on treatment (diet or insulin administration). Methods This study includes 16 cases of GDM with singleton pregnancies, who attended the outpatient clinic of the University General Hospital of Heraklion, Heraklion, Greece, and had no comorbidities. The control group consisted of 25 healthy pregnant women who visited the same outpatient clinics during the same period. Personal data were collected through anonymous questionnaires regarding age, number of previous pregnancies, and any existing conditions. In cases of GDM, women were categorized based on whether they were treated with insulin or managed with a carbohydrate-restricted diet. Biochemical markers - pregnancy-associated plasma protein A (PAPP-A) and β-human chorionic gonadotrophin (β-hCG) - were measured. These levels were converted to MoM (multiples of the normal median) values, allowing direct comparison with expected values for gestational age. Ultrasonographic indices - uterine artery pulsatility index (Ut-A PI) and large for gestational age (LGA) - were assessed using the ultrasound Voluson 730 (General Electric, Boston, MA, USA) device in the Gynecology-Obstetrics Department. Results Our results showed a trend for reduced β-hCG levels in the GDM group compared to the control group, but these levels tended to be higher in the GDM subgroup treated with insulin. Ut-A PI was reduced in the GDM subgroup with insulin, and there were more LGA fetuses. Age was positively associated with β-hCG in the diet group. The same group had PAPP-A positively associated with age and Ut-A PI in a linear fashion, and negatively associated with the number of previous pregnancies. In the insulin-treated GDM group, PAPP-A was positively correlated with Ut-A PI (in a linear fashion), LGA, and negatively with β-hCG. Conclusion In this article, we recommend early, universal screening of all pregnant women during the early weeks of the first trimester. Biochemical markers, in association with fasting plasma glucose levels, would predict the risk of gestational diabetes in the pregnant woman. We suggest early testing and intervention to prevent the development of fetal hyperinsulinemia and reduce the likelihood of metabolic disease later in life.