Predictive value of serum chemerin level trajectory in the second and third trimesters for pregnancy outcomes in patients with gestational diabetes mellitus

Gu Yuanyuan; Huang Yinwei; Yang La

doi:10.3760/j.issn.1673-4777.2026.07.016

Abstract：Objective To analyze the predictive value of serum chemerin level trajectory in the second and third trimesters for pregnancy outcomes in patients with gestational diabetes mellitus(GDM).Methods A total of 210 GDM patients admitted to the Affiliated Hospital of Guizhou Medical University from January 2023 to July 2024 were enrolled as the GDM group,and 105 healthy pregnant women as the control group.Serum chemerin levels at 24 weeks,32 weeks of gestation and before delivery were compared between the two groups.Latent class trajectory modeling(LCTM)was used to identify subgroups with different serum chemerin trajectories in the GDM group.All GDM patients were followed up until delivery to record adverse pregnancy outcomes.Serum chemerin levels,baseline characteristics and incidence of adverse pregnancy outcomes were compared among different trajectory subgroups.Logistic regression was used to analyze the correlation between chemerin trajectory and adverse pregnancy outcomes.Receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of chemerin trajectory for adverse pregnancy outcomes.Results Serum chemerin levels showed no significant change at 24 weeks,32 weeks and before delivery in the control group(P＞0.05),but decreased gradually in the GDM group(P＜0.001).Serum chemerin levels in the GDM group were significantly higher than those in the control group at all three time points(all P＜0.001).LCTM identified three optimal trajectory subgroups:T1(low to relatively low chemerin level,n=65),T2(moderately high to low level,n=92),and T3(persistently high level,n=53).The overall incidence of adverse pregnancy outcomes in the GDM group was 24.8％(52/210).Pre-pregnancy body mass index,2 h 75 g oral glucose tolerance test(OGTT)blood glucose,glycated hemoglobin(HbA1c),homeostasis model assessment of insulin resistance,serum chemerin levels at all time points and adverse pregnancy outcome rate were highest in T3,followed by T2 and then T1(all P＜0.05).OGTT 2 h glucose,HbA1c and chemerin trajectory were independent risk factors for adverse pregnancy outcomes(all P＜0.05).After adjustment for OGTT 2 h glucose and HbA1c,chemerin trajectory remained an independent risk factor(P＜0.05).The area under the curve of persistently high chemerin trajectory for predicting adverse pregnancy outcomes was 0.852,with a sensitivity of 80.77％,specificity of 84.81％and Youden index of 0.656.Conclusions Serum chemerin trajectory in the second and third trimesters is significantly correlated with pregnancy outcomes in GDM patients.A persistently high chemerin level trajectory has high predictive efficacy for adverse pregnancy outcomes.