Elevated first trimester C-reactive protein as a predictor of gestational diabetes


  • Sanjay Parihar Consultant Physician, Government District Hospital, Kishtwar, Jammu and Kashmir, India
  • Rajesh Singh Consultant Physician, Community Health Centre, Gundoh, Doda, Jammu and Kashmir, India




C-Reactive Protein, First Trimester, Gestational Diabetes, Predictor


Background: The incidence of type 2 diabetes is increasing at an alarming rate, particularly among young women. GDM is a unique prediabetes state that shares common risk factors with type 2 diabetes, and similar alterations in carbohydrate metabolism. Objectives of this study the elevation of C-reactive protein in the first trimester of pregnancy as a predictor of gestational diabetes.

Methods: This hospital-based study comprised of patients (Primigravida) visiting the obstetric OPD or admitted in Obstetric wards. Detailed history and clinical examination of the patient was recorded on a Proforma. Blood samples of patients were taken for: (i) C-reactive protein in first trimester of pregnancy; and (ii) Blood sugar (fasting & post-prandial) during their first antenatal visit and patients were followed up in subsequent visits in second and third trimester for development of gestational diabetes.

Results: There were seven women who developed gestational diabetes and had elevated first trimester C- reactive protein levels as compared to other group in which only two women developed gestational diabetes mellitus but did not have elevated C-reactive protein in their first trimester. However, there were two women, who had elevated C-reactive protein, but did not subsequently develop gestational diabetes mellitus and women with C-reactive protein in normal range who did not develop gestational diabetes mellitus were 56.

Conclusion: An association between first trimester inflammation marked by increased CRP levels, and subsequent risk of development of GDM has been identified.


Ergun-Longmire B, Maclaren NK. Etiology and Pathogenesis of Diabetes Mellitus IN Children. In: Feingold KR, Anawalt B, Boyce A. editors. Endotext. South Dartmouth (MA): MDText.com. Available at: https://www.ncbi.nlm.nih.gov/books/NBK278937/ Accessed on 20 June 2018.

Simmons KM, Michels AW. Type 1 diabetes: A predictable disease. World J Diabetes. 2015;6(3):380-90.

Gosmanov AR, Gosmanova EO, Kitabchi AE. Hyperglycemic Crises: Diabetic Ketoacidosis (DKA), And Hyperglycemic Hyperosmolar State (HHS). In: Feingold KR, Anawalt B, Boyce A, editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279052/ Accessed 28 May 2018.

Virjee S, Robinson S, Johnston DG. Screening for diabetes in pregnancy. J R Soc Med. 2001;94(10):502-9.

Rani PR, Begum J. Screening and Diagnosis of Gestational Diabetes Mellitus, Where Do We Stand. J Clin Diagn Res. 2016;10(4):QE01-4.

Ormazabal V, Nair S, Elfeky O, Aguayo C, Salomon C, Zuñiga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17(1):122.

Puavilai G, Drobny EC, Domont LA, Baumann G. Insulin receptors and insulin resistance in human pregnancy: evidence for a postreceptor defect in insulin action. J Clin Endocrinol Metab. 1982;54(2):247-53.

Buschur E, Stetson B, Barbour LA. Diabetes In Pregnancy. In: Feingold KR, Anawalt B, Boyce A. editors. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279010/ Accessed on 5 April 2018.

Ares J, Martín-Nieto A, Díaz-Naya L, Tartón T, Menéndez-Prada T, Ragnarsson CS, et al. Gestational Diabetes Mellitus (GDM): Relationship Between Higher Cutoff Values for 100 g Oral Glucose Tolerance Test (OGTT) and Insulin Requirement During Pregnancy. Matern Child Health J. 2017;21(7):1488-1492.

Mohsin F, Khan S, Baki MA, Zabeen B, Azad K. Neonatal management of pregnancy complicated by diabetes. J Pak Med Assoc. 2016 Sep;66(9):S81-4.

Fonseca FA, Izar MC. High-Sensitivity C-Reactive Protein and Cardiovascular Disease Across Countries and Ethnicities. Clinics (Sao Paulo). 2016;71(4):235-42.

Zheng Y, Zhang G, Chen Z, Zeng Q. Relationship between Type 2 Diabetes and Inflammation Diseases: Cohort Study in Chinese Adults. Iran J Public Health. 2015;44(8):1045-52.

Chen L, Deng H, Cui H, Fang J, Zuo Z, Deng J, et al. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2017;9(6):7204-18.

Ellulu MS, Patimah I, Khaza'ai H, Rahmat A, Abed Y. Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017;13(4):851-63.

Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw. 2006;17(1):4-12.

Ouchi N, Kihara S, Funahashi T, Matsuzawa Y, Walsh K. Obesity, adiponectin and vascular inflammatory disease. Curr Opin Lipidol. 2003;14(6):561-6.

Black PH. The inflammatory consequences of psychologic stress: relationship to insulin resistance, obesity, atherosclerosis and diabetes mellitus, type II. Med Hypotheses. 2006;67(4):879-91.

Timpson NJ, Nordestgaard BG, Harbord RM, Zacho J, Frayling TM, Tybjærg-Hansen A, et al. C-reactive protein levels and body mass index: elucidating direction of causation through reciprocal Mendelian randomization. Int J Obes (Lond). 2011;35(2):300-8.

Wang Z, Nakayama T. Inflammation, a link between obesity and cardiovascular disease. Mediators Inflamm. 2010;2010:535918.

Paoletti R, Bolego C, Poli A, Cignarella A. Metabolic syndrome, inflammation and atherosclerosis. Vasc Health Risk Manag. 2006;2(2):145-52.

Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575-84.

Laakso M. Cardiovascular disease in type 2 diabetes from population to man to mechanisms: the Kelly West Award Lecture 2008. Diabetes Care. 2010;33(2):442-9.

Devaraj S, Singh U, Jialal I. Human C-reactive protein and the metabolic syndrome. Curr Opin Lipidol. 2009;20(3):182-9.

Ramsay JE, Ferrell WR, Crawford L, Wallace MA, Greer IA. Maternal obesity is associated with dysregulation of metabolic, vascular, and inflammatory pathways. J Clin Endocrinol Metab. 2002;87:4231-7.

Pan A, Wang Y, Yuan JM, Koh WP. High-sensitive C-reactive protein and risk of incident type 2 diabetes: a case-control study nested within the Singapore Chinese Health Study. BMC Endocr Disord. 2017;17(1):8.

Kirwan JP, Hauguel-De Mouzon S, Lepercq J, Challier JC, Huston-Presley L, Friedman JE, et al. TNF-alpha is a predictor of insulin resistance in human pregnancy. Diabetes. 2002;51(7):2207-13.






Original Research Articles