First-trimester blood urea nitrogen and risk of gestational diabetes mellitus

Abstract

Prior studies indicated that urea increased insulin resistance and higher blood urea nitrogen (BUN) was associated with incident diabetes mellitus. However, it remains unclear whether BUN during the first trimester of pregnancy increases risk of gestational diabetes mellitus (GDM). We aimed to investigate the association between first-trimester BUN and risk of incident GDM. We conducted a prospective, multicenter cohort study of pregnant women. A total of 13 448 eligible pregnant women with measured first-trimester BUN levels were included in this analysis. Logistic regression analysis was used to estimate the relationship between BUN and GDM. Discrimination and reclassification for GDM by BUN were analysed. A total of 2973 (22.1%) women developed GDM. Compared with the lowest quartile of BUN, the third and fourth quartiles were associated with increased risk of GDM (adjusted odds ratios 1.21 [95% CI 1.07-1.37] and 1.50 [95% CI 1.33-1.69], respectively, P for trend <.001). The addition of BUN to conventional factor model improved discrimination (C statistic 0.2%, P = .003) and reclassification (net reclassification index 14.67%, P < .001; integrated discrimination improvement 0.12%, P < .001) for GDM. In conclusion, higher BUN concentrations during the first trimester of pregnancy were associated with increased risk of GDM, suggesting that BUN could be a potential predictor for GDM.

Keywords: blood urea nitrogen; chronic kidney disease; gestational diabetes mellitus; insulin resistance.

Figure 1

Association of blood urea nitrogen with the development of gestational diabetes mellitus. ORs and 95% confidence intervals derived from restricted cubic spline regression, with knots placed at the 5th, 35th, 65th and 95th percentiles of the distribution of serum blood urea nitrogen. Reference point of serum BUN is the mid‐point (2.10 mmol/L) of the reference group from categorical analysis. ORs were adjusted for maternal age, education, gravidity, parity, baseline BMI, gestational weight gain, systolic BP, FPG, WBC, haemoglobin and eGFR