The mediating role of inflammation in the association between pregnancy loss history and gestational diabetes mellitus

BACKGROUND: To assess the association of pregnancy loss history with an elevated risk of Gestational diabetes mellitus (GDM) and to investigate whether this association was mediated by high-sensitivity C-reactive protein (hs-CRP). METHODS: We prospectively collected venous blood and pregnancy loss history information from 4873 pregnant women at 16–23 weeks of gestation from March 2018 to April 2022. Hs-CRP concentrations were measured from collected blood samples. A 75 g fasting glucose test was performed at 24 to 28 weeks of gestation for the diagnosis of GDM, with data obtained from medical records. Multivariate linear or logistic regression models and mediation analysis were used to examine the relationships between pregnancy loss history, hs-CRP, and GDM. RESULTS: A multivariable-adjusted logistic regression analysis revealed that compared with pregnant women with no induced abortion history, subjects with 1 and ≥ 2 induced abortions had a higher risk for GDM (RR = 1.47, 95% CI = 1.19–1.81; RR = 1.63, 95% CI = 1.28–2.09). Additionally, the mediation analysis indicated this association was mediated by an increased hs-CRP level with a 20.4% of indirect effect ratio. However, no significant association between a history of miscarriage and the prevalence of GDM was observed. CONCLUSIONS: A history of induced abortion was significantly associated with an increased risk of GDM, and this association occurred in a dose-response effect. Hs-CRP may be accounted for a mediation effect in the pathways linking induced abortion history with GDM.