关键词: 妊娠期糖尿病, 微小核糖核酸-15a, 微小核糖核酸-195-5p, 微小核糖核酸-33, 母体妊娠结局, 围生儿妊娠结局

Abstract:

Objective To investigate the expression levels of serum microRNA-15a （miR-15a）， microRNA-195-5p （miR-195-5p）， and microRNA-33 （miR-33） in pregnant women with gestational diabetes mellitus （GDM） and to explore their associations with maternal and neonatal outcomes. Methods The research subjects were selected from 208 patients with GDM who completed delivery at our hospital between September 2021 and October 2024. Based on maternal pregnancy outcomes， the subjects were categorized into either the poor maternal outcome group or the good maternal outcome group. Similarly， they were classified into the poor perinatal outcome group and the good perinatal outcome group according to perinatal outcomes. Clinical data and serum levels of fasting plasma glucose （FPG）， miR-15a， miR-195-5p， and miR-33 were collected and compared between groups with different maternal and perinatal outcomes. Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse maternal and perinatal outcomes among GDM patients. Additionally， the predictive value of these biomarkers for adverse maternal and perinatal outcomes was evaluated using receiver operating characteristic （ROC） curve analysis. Results Among 208 patients with GDM， 81 experienced adverse maternal pregnancy outcomes （38.94%）. Of the 192 newborns， 51 cases were associated with adverse perinatal outcomes， resulting in an incidence rate of 26.56%. Multivariate logistic regression analysis revealed that a high insulin resistance index （OR = 2.197）， poor glycemic control （OR = 2.482）， a history of adverse pregnancy or childbirth （OR = 2.838）， elevated FPG levels （OR = 1.910）， increased serum expression of miR-15a （OR = 1.988）， miR-195-5p （OR = 2.273）， and miR-33 （OR = 2.479） were independent risk factors for adverse maternal pregnancy outcomes in GDM patients （P < 0.05）. The area under the receiver operating characteristic curve （AUC） for the combined detection of miR-15a， miR-195-5p， and miR-33 was higher than that of FPG alone in predicting maternal pregnancy outcomes， with the combined detection showing the highest AUC （P < 0.05）. Similarly， multivariate logistic regression results also indicated that elevated levels of the aforementioned biomarkers—insulin resistance index （OR = 2.155）， poor glycemic control （OR = 2.408）， history of adverse pregnancy or childbirth （OR = 2.838）， FPG （OR = 2.018）， miR-15a （OR = 2.197）， miR-195-5p （OR = 2.246）， and miR-33 （OR = 3.043）—were independent risk factors for adverse perinatal outcomes in GDM patients （P < 0.05）. The AUC for combined detection of miR-15a， miR-195-5p， and miR-33 was significantly higher than that of FPG alone in predicting perinatal outcomes， with the combination yielding the highest predictive accuracy （P < 0.05）. Conclusions Patients with GDM are at increased risk of adverse maternal and perinatal outcomes. Elevated insulin resistance index， poor glycemic control， a history of adverse pregnancy or childbirth， and increased serum levels of miR-15a， miR-195-5p， and miR-33 were identified as independent risk factors for adverse pregnancy outcomes in individuals with gestational diabetes. The individual measurement of miR-15a， miR-195-5p， and miR-33， as well as their combined detection， demonstrated greater predictive value for pregnancy outcomes in GDM patients compared to FPG alone， with the combined detection showing the highest predictive accuracy.

Key words: gestational diabetes mellitus, micro ribonucleic acid-15a, micro ribonucleic acid-195-5p, micro ribonucleic acid-33, maternal pregnancy outcome, pregnancy outcome of perinatal infants