Afamin as an Independent Diagnostic Marker of Gestational Diabetes Mellitu

Authors

  • Jawaria Asghar Department of Chemical Pathology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Uzma Naeem Department of Chemical Pathology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Afshan Bibi Department of Chemical Pathology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Qamar ud din Khan Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS), Pakistan
  • Zunnera Sajjad Department of Hematology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Rafia Irfan Department of Microbiology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-7.12423

Keywords:

Afamin, Gestational Diabetes Mellitus, Oral Glucose Tolerance Test

Abstract

Objectives: To assess utility of afamin (AFM) as an independent marker of Gestational Diabetes Mellitus (GDM) in comparison with Oral Glucose Tolerances Test (OGTT), and to determine cut off value for afamin.

Study Design: Diagnostic accuracy study.

Place and Duration of Study: Chemical Pathology and Gynecology Department, Army Medical College and Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Dec 2021.

Methodology: Ninety-six pregnant females with history of 24 to 28 weeks of gestation were included in this study, out of which 48 were cases of GDM (Group-A) and 48 were included in age and gestation matched control group (Group-B). Fasting plasma glucose was taken for 75g OGTT and Afamin (AFM) levels. AFM concentrations were compared with OGTT results between the two groups.

Results: Median age of cases was 30.0(3.0) years and of controls was 29.5(5.0) years. A significant difference was found in the median values of serum afamin, fasting plasma glucose and 1- and 2-hours plasma glucose post-glucose load between Group-A and Group-B. The optimal cut off level of serum afamin for diagnosing GDM was determined as 71.2 mg/L, with Area Under Curve (AUC) 0.993, sensitivity 97.9% and specificity 79.0%.  AUC for serum afamin levels was greater than HbA1c, fasting plasma glucose and 1-hour plasma glucose post-glucose load.

Conclusion: Median second trimester serum afamin levels were significantly higher in Group-A as compared to Group-B, making it a reliable test for GDM in second trimester.

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References

1. Staimez LR, Kipling LM, Ham JN, Legvold BT, Jackson SL, Wilson PW, et al. Potential misclassification of diabetes and prediabetes in the US: mismatched HbA1c and glucose in NHANES 2005–2016. Diab Res Clin Pract 2022; 189: 109935.

https://doi.org/10.1016/j.diabres.2022.109935

2. Ruszała M, Pilszyk A, Niebrzydowska M. Novel biomolecules in the pathogenesis of gestational diabetes mellitus. Int J Mol Sci 2022; 23(8): 4364. https://doi.org/10.3390/ijms23084364

3. Adnan M, Aasim M. Prevalence of gestational diabetes mellitus in Pakistan: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24(1): 108.

https://doi.org/10.1186/s12884-024-06290-9

4. Casas LA, Alarcón J, Urbano A, Peña-Zárate EE, Sangiovanni S, Libreros-Peña L et al. Telemedicine for the management of diabetic patients in a high-complexity Latin American hospital. BMC Health Serv Res 2023; 23(1): 314.

https://doi.org/10.1186/s12913-023-09267-0

5. Rathnayake H, Han L, daSilva F. Advancement in predictive biomarkers for gestational diabetes mellitus diagnosis and related outcomes: a scoping review. BMJ Open 2024; 14: e089937. https://doi.org/10.1136/bmjopen-2024-089937

6. Hu SL, He BT, Zhang RJ. Association between maternal alcohol use during pregnancy and gestational diabetes mellitus: a meta-analysis. Int J Diabetes Dev Ctries 2021; 41(2): 189-195.

https://doi.org/10.1007/s13410-020-00877-6

7. Sweeting A, Hannah W, Backman H, Catalano P, Feghali M, Herman WH, et al. Epidemiology and management of gestational diabetes. Lancet 2024; 404(10448): 175-192.

https://doi.org/10.1159/000480161

8. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33(3): 676-682.

https://doi.org/10.2337/dc09-1848

9. Adam S, Pheiffer C, Dias S, Rheeder P. No association between gestational diabetes and biomarkers: a role in diagnosis. J. Biomark 2018; 23(4): 386-391.

https://doi.org/10.2147/DMSO.S294328

10. Wu S, Li L, Hu KL. A Prediction Model of Gestational Diabetes Mellitus Based on OGTT in Early Pregnancy: A Prospective Cohort Study. J Clin Endocrinol Metab 2023; 108: 1998–2006.

https://doi.org/10.1210/clinem/dgad052

11. Kunick Mi, Rzewuska N, Sopońska P, Pawłosek A, Sowińska I, Kloska A. Novel serum biomarkers for early diagnosis of gestational diabetes mellitus—a review. J Gynaecol Endocrinol 2025; 41(1): 2455472.

https://doi.org/10.1080/09513590.2025.2455472

12. Wang X, Zheng X, Yan J. The Clinical Values of Afamin, Triglyceride and PLR in Predicting Risk of Gestational Diabetes During Early Pregnancy. Front Endocrinol 2021; 12: 723650. https://doi.org/10.3389/fendo.2021.723650

13. Atakul N, Atamer Y, Selek S, Kılıç B, Unal F: Novel Metabolic Marker Afamin: A Predictive Factor for Large-for-Gestational-Age (LGA) Fetus Estimation in Pregnancies with Gestational Diabetes Mellitus? J Gynecol Obstet Hum Reprod 2021; 102201(2): e102201.

https://doi.org/10.1016/j.jogoh.2021.102201

14. Yuan Y, He W, Fan X. Serum afamin levels in predicting gestational diabetes mellitus and preeclampsia: a systematic review and meta-analysis. Front Endocrinol 2023; 14(2): 1157114. https://doi/org/10.3389/fendo.2023.1157114

15. Cai Z, Yang Y, Zhang J. Hepatokine levels during the first or early second trimester of pregnancy and the subsequent risk of gestational diabetes mellitus: A systematic review and meta-analysis. J Biomark. 2021; 26(6): 517-531.

https://doi.org/10.1080/1354750X.2021.1928754

16. American Diabetes Association Professional Practice Committee. Standards of care in Diabetes- 2023. Diabetes Care 2023; 48(1): 542-543.

https://www.bluecirclehealth.org/wp content/uploads/2023/06/ADA_SoC_ch5.pdf

17. Chen LW, Soh SE, Tint MT, Loy SL, Yap F, Tan KH, et al. Combined analysis of gestational diabetes and maternal weight status from pre-pregnancy through post-delivery in future development of type 2 diabetes. Sci Rep 2021; 11(1): 5021.

https://doi.org/10.1038/s41598-021-82789-x

18. Dogan Y, Arslan O, Oztas B, Kurtali A, Daryal AS, Eser MD. Comparison of Afamin Values in Umbilical Cord Blood After Delivery in Pregnancies With and Without Gestational Diabetes Mellitus. Fetal Pediatr Pathol 2024; 43(2): 83-93.

https://doi.org/10.1080/15513815.2023.2300981

19. Li Q, Li C, Jin J, Shen Y, Wang M. Clinical significance of neuregulin 4, afamin, and SERPINB1 in gestational diabetes mellitus and their relationship with insulin resistance. J Evid-Based Complement Altern Med 2022; 2022(1): 2829662.

https://doi.org/10.1155/2022/2829662

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Published

29-11-2025

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Section

Original Articles

How to Cite

1.
Asghar J, Naeem U, Bibi A, Khan Q ud din, Sajjad Z, Irfan R. Afamin as an Independent Diagnostic Marker of Gestational Diabetes Mellitu. Pak Armed Forces Med J [Internet]. 2025 Nov. 29 [cited 2025 Dec. 6];75(SUPPL-7):S1073-S1077. Available from: https://pafmj.org/PAFMJ/article/view/12423