Superiority of neutrophil count over other inflammatory markers in predicting gestational diabetes: A prospective cohort study

Background: To investigate the predictive values of blood cell components and blood cells-derived inflammatory indices for predicting gestational diabetes mellitus (GDM). Methods: This study is part of the Qazvin Maternal and Neonatal Metabolic Study (QMNMS) in Iran (2018-2021. The association of blood cells and blood cell-derived inflammatory indices including neutrophil to lymphocyte ratio (NLR), systemic inflammatory response index (SIRI), systemic immune inflammation index (SII), and aggregate systemic inflammatory response index (AISI) in early pregnancy with early insulin resistance and development of GDM in following months was investigated using univariate and multivariate statistical analysis. Results : The final analysis was performed on 612 participants. GDM developed in 96 participants (15,7%). In univariate analysis, neutrophil quartiles had the highest predictive value for GDM development. Lymphocytes and monocytes quartiles were not associated with GDM development. In the fully adjusted model, neutrophil quartiles remained the strongest predictors of GDM development with relative risks of 3.7, 4.2, and 8.3 for 2 nd , 3 rd , and 4 th neutrophil quartiles compared to the first quartile (P<0.001). Other inflammatory indices including NLR, SIRI, SII, and AISI had no additional yield to predict GDM. Despite the strong associate of neutrophil quartiles with GDM, there was no association between neutrophil counts and early pregnancy insulin resistance assessed by Homeostasis of Model Assessment -Insulin Resistance (HOMA-IR). Conclusion : Neutrophil count is the best predictor of GDM development among blood cell components and blood cell-derived inflammatory indices. The role of neutrophils in GDM development is independent of early pregnancy insulin resistance.