Study on the relationship of maternal serum cortisol and low-grade inflammation indices with some preeclampsia risks and fetal growth indices by ultrasound in first-time diagnosed gestational diabetes mellitus

Gestational Diabetes Mellitus (GDM) is a significant pregnancy complication, characterized by insulin resistance and high blood glucose, which profoundly affects maternal and fetal health. Common complications include preeclampsia and chronic low-grade inflammation (LGI), contributing to insulin resistance. Maternal cortisol plays a dual role, being essential for neurodevelopment yet potentially detrimental at high levels. Given the identified research gap concerning the comprehensive interplay between maternal cortisol, LGI, insulin resistance, and fetal growth in GDM, this study aims to describe these factors and investigate their relationships with preeclampsia risks and fetal growth indices. Understanding these complex interactions is crucial for improving pregnancy outcomes in women with GDM.

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This cross-sectional study investigated the complex relationships between maternal serum cortisol, low-grade inflammation (LGI) indices, preeclampsia risks, and fetal growth indices, as measured by ultrasound, in 248 first-time diagnosed Gestational Diabetes Mellitus (GDM) patients and 48 normal glucose-tolerant pregnant women. Conducted over a decade (2015-2024) at two major hospitals, the study meticulously analyzed parameters including serum cortisol levels, platelet-to-lymphocyte ratio (PLR), and neutrophil-to-lymphocyte ratio (NLR), alongside fetal ultrasound indices such as abdominal circumference (AC), estimated fetal weight (EFW), biparietal diameter (BPD), and head circumference (HC).

The key findings revealed significantly elevated serum cortisol, PLR, and NLR in GDM patients compared to the control group. LGI indicators (PLR, NLR) were strongly associated with increased preeclampsia risks, particularly in older mothers (>35 years) and those with higher systolic blood pressure and BMI. Notably, maternal cortisol positively correlated with fetal AC and EFW, suggesting a potential role in larger fetal dimensions. Conversely, LGI indices (NLR, PLR) demonstrated negative correlations with various fetal growth parameters, including EFW, AC, BPD, and HC, even after adjusting for maternal BMI and fasting plasma glucose. These results underscore the critical importance of comprehensively monitoring both maternal cortisol and LGI in GDM management. The insights gained are crucial for identifying at-risk pregnancies, understanding the mechanisms linking GDM to adverse outcomes, and potentially informing targeted interventions to mitigate preeclampsia risk and optimize fetal ultrasound index deviations for improved maternal and fetal health.