Efficiency of afamin and fibroblast growth factor 21 for early prediction of gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is among the most common complications during pregnancy. It is characterized by hyperglycemia that is first identified during pregnancy, typically in the second or third trimesters. However, the relatively late diagnosis limits timely glycemic control and preventive interventions. The present study aimed to evaluate the diagnostic potential of serum afamin and fibroblast growth factor 21 (FGF21) as early predictive biomarkers for GDM. The study involved 17 healthy pregnant women and 26 pregnant women with one or more risk factors for developing GDM. Fasting blood samples were collected in the 1st (8-12 weeks) and 2nd (22-28 weeks) trimesters of pregnancy. Higher serum afamin level was observed in GDM group at 1st trimester (92.9 ± 34.51 ng/ml) compared to normal pregnancy (57.1 ± 25.15 ng/ml). At 2nd trimester, no significant difference in circulated serum afamin was noted between the two groups (73.2 ± 20.30 ng/ml and 68.3 ± 18.74 ng/ml, for GDM and normal pregnancy, respectively). The study also indicated higher serum FGF21 in pregnancy complicated with GDM compared to normal pregnancy at both sampling times (1st trimester: 140.8 ± 32.83 and 97.1 ± 21.43 Pg/ml for GDM and normal; 2nd trimester: 123.8 ± 41.85 and 89.4 ± 32.53 Pg/ml for GDM and normal). At 1st trimester no significant correlations were noted between afamin and all parameters in normal pregnancy, however, in pregnancy complicated with GDM, positive correlations were noted between the hormone and the diabetic profile parameters and baby birth weight. At both 1st and 2nd trimesters, no correlation between FGF21 with all tested parameters, either in normal or complicated pregnancies. ROC curve analysis demonstrated that afamin (AUC = 0.826, P < 0.001), FGF21 (AUC = 0.877, P < 0.001), and their combined assessment (AUC = 0.9, P < 0.001) were strong predictors of GDM development at 1st trimester before the development of the disease than expectant mothers with normal pregnancy.