Study of the prognostic value of SFLT-1, P1GF levels and SFLT-1/PIGF ratios in maternal and cord blood in pregnants diagnosed with gestational diabetes mellitus, and the changes in these values on time of delivery and maternal-fetal complications

Aim: The aim of this study; to find SFLT-1 and PlGF levels and SFLT- 1/PlGF ratio in serum samples obtained from maternal blood (between 30-34 weeks of gestation) and cord blood (at the time of delivery) from pregnant women diagnosed with gestational diabetes mellitus and to determine these angiogenic factors' relationship with gestational diabetes mellitus. Materials and Methods: This study was carried out as a prospective cohort study and 108 pregnant women who applied to Akdeniz University Faculty of Medicine, Department of Obstetrics and Gynecology between 01.10.2021 and 01.12.2022, were screened with 75 grams OGTT, 51 were diagnosed with GDM and 57 were not diagnosed with GDM were included in the study. SFLT-1 value, PlGF value and SFLT-1/PlGF ratio were measured in blood samples from maternal antecubital vein were obtained 30-34th weeks of gestation and cord blood samples were obtained during delivery. To check the PlGF and SFLT-1 levels, the blood samples taken into 10 mL gel separator tubes were centrifuged at 4000 rpm for 10 minutes and the plasma part was separated and stored at minus 80°C until the studies were conducted. Plasma SFLT-1 and PlGF levels were measured by ELISA method using commercial kits. Results: While no significant difference was observed in terms of PlGF values obtained from maternal blood of the control and GDM group patients (p=0.106), it was observed that the median value of PlGF obtained from cord blood was lower in the GDM group (0.29 [IQR: 0.25-0.38] and 0, 36 [IQR: 0.27- 0.53]; p=0.017). The median value of SFLT-1 from cord blood was found to be significantly lower in the GDM group (8.16 [IQR: 6.56-10.18] and 11.09 [7.93- 15.02]; p=0.003). Conclusion: There was no significant difference between control and GDM groups in PlGF and SFLT-1 levels and SFLT-1/PlGF ratios in samples taken from maternal blood. Therefore, the use of these biomarkers for the prediction or diagnosis of GDM at or before the OGTT week does not seem appropriate. However, PlGF and SFLT-1 levels were found to be significantly lower in the GDM group in the samples taken from the cord blood. Moreover, SFLT-1 levels in the cord blood were found to be statistically significantly lower in the unregulated blood glucose GDM group. We predict that it occurs as a result of oxidative stress due to impaired blood glucose regulation in GDM. Further, sufficiently strong clinical, prospective studies are needed to better elucidate the role of these biomarkers in the pathogenesis of gestational diabetes. Future research should focus on the role of angiogenic factors such as PlGF and SFLT-1 in the pathogenesis of GDM. Key Words: Gestational Diabetes Mellitus, PlGF, SFLT-1, 75-gram OGTT, Angiogenic Marker