Objective  To investigate the level of serum microRNA-21 (miR-21), pancreatic derived factor (PANDER), pregnancy-associated plasma protein A (PAPP-A) in gestational diabetes mellitus (GDM) and their predictive effect on adverse pregnancy outcomes in GDM patients.

Methods  Patients admitted to the Youxian Maternal and Child Health Hospital of Mianyang from January 2020 to September 2022 were selected as the GDM group and another normal pregnant women who underwent prenatal examinations during the same time were selected as the control group. Compare the clinical data and serum miR-21, PANDER, and PAPP-A levels between two groups. Both groups were followed up until the postpartum and pregnancy outcomes were counted. Multivariate Logistic regression analysis was used to explore the factors influencing the occurrence of adverse pregnancy outcomes in patients with GDM. The receiver operating characteristic (ROC) curve and area under curve (AUC) were used to analyze the value of indicators in predicting the adverse pregnancy outcomes.

Results  308 subjects were included, with 154 in each group.The fasting plasma glucose levels, PANDER, PAPP-A, and miR-21 in the GDM group were higher than those in the control group (P<0.05). The hypoglycemia frequency and the levels of fasting plasma glucose, PANDER, PAPP-A, miR-21 in the adverse pregnancy group were higher than those in the good pregnancy group(P<0.05). Multivariate Logistic regression analysis shows that, after adjusting confounding factors, hypoglycemia frequency [OR=4.526, 95%CI (2.014, 10.171)], PANDER[OR=1.011, 95%CI (1.001, 1.021)], PAPP-A[OR=1.215, 95%CI (1.069, 1.382)] and miR-21[OR=11.143, 95%CI (2.115, 58.712)] were significantly associated with the risk of adverse pregnancy outcomes in GDM patients (all P<0.05). ROC curve analysis shows that, the AUC of the combination of hypoglycemia frequency, PANDER, PAPP-A and miR-21 in predicting the adverse pregnancy outcomes were [0.950, 95%CI(0.907, 0.993)], higher than that of each single indicator.

Conclusion Compared with normal pregnant women, the serum levels of miR-21, PANDER and PAPP-A were increased in GDM patients, and the levels of miR-21, PANDER and PAPP-A were risk factors for adverse pregnancy outcomes. miR-21, PANDER and PAPP-A may be used as biological indicators to evaluate the pregnancy outcome of GDM.

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