Deregulated Levels of Vascular Endothelial Growth Factor, Tumor Necrosis Factor-α and Total Cholesterol Early in Pregnancy may Predict Oncoming Gestational Diabetes Mellitus

Objectives: Evaluation of the relationship between mater-nal glycemia and lipidemic statuses, serum levels of vas-cular endothelial growth factor (VEGF) and tumor necro-sis factor-α (TNF-α) at the 6th gestational week (GW) and the development of gestational diabetes mellitus (GDM) among non-diabetic pregnant women.
Patients & Methods: 169 newly pregnant women, 20 non-pregnant/non/diabetic (NP/ND) and 20 non-pregnant/diabetic (NP/D) women underwent 75-Oral glucose toler-ance test (OGTT) and gave blood samples for estimation of blood levels of glycosylated hemoglobin A1c (HbA1c), plasma lipid profile and serum levels of VEGF and TNF-α at the 6th GW of the pregnant women and the 24th GW, OGTT was repeated to define GDM women.  
Results: At the 24th GW, OGTT defined 37 women had GDM and 132 were non-GDM. At the 6th GW, NP/D and GDM women had significantly higher fasting blood glucose (FBG), total cholesterol (TC), triglycerides (TG), and very low-density lipoprotein (VLDL) with significantly lower high-density lipoprotein (HDL-c) compared to NP/ND wom-en, but differences were non-significant between non-GDM and NP/ND women. At-enrolment means serum levels of TNF-α were significantly lower in samples of NP/ND than in samples of women of other groups that showed non-sig-nificant differences. On contrary, at-enrolment mean serum levels of VEGF were significantly higher in NP/D and GDM women, while were non-significantly higher in non-GDM women compared to NP/ND. Moreover, at-enrolment serum VEGF levels were significantly lower in pregnant women compared to NP/D women with significantly lower levels in non-GDM than GDM women. Statistical analyses defined high at-enrolment plasma TC and serum VEGF and TNF-α as the most significant predictors for GDM during pregnancy progress. Kaplan-Meier Regression analysis showed that the risk for the development of GDM was increased by 50% at a plasma TC level of 217 mg/ml (95%CI: 215.2-218.8), serum VEGF at 137 pg/ml (95%CI: 132.2-151.8) and TNF-α level at 3.49 (95%CI: 3.35-3.97). 
Conclusion: GDM may be related to the in-terplay between high levels of VEGF, inflam-matory cytokines, and hyperlipidemia. High blood levels of VEGF and TC can discriminate against women vulnerable to developing GDM with high sensitivity, specificity, and negative predictive values.