Estradiol-to-follicle ratio on human chorionic gonadotropin day is a novel predictor of gestational diabetes mellitus in women receiving fresh embryo transfer

Front Endocrinol (Lausanne). 2024 Oct 11:15:1465069. doi: 10.3389/fendo.2024.1465069. eCollection 2024.

Abstract

Aims: To assess the predictive value of estradiol (E2) related parameters on the incidence of gestational diabetes mellitus (GDM) in women undergoing fresh embryo transfer.

Materials and methods: A Post-hoc analysis of a prospective cohort study.

Results: We identified an optimal E2/follicle (E2/F) ratio threshold of 246.03 pg/ml on the day of human chorionic gonadotropin (hCG) administration. Women with an E2/F ratio exceeding this threshold had significantly lower rates of GDM (12.75% vs. 20.41%, P < 0.001) and ovarian hyperstimulation syndrome (OHSS) (11.75% vs. 15.48%, P = 0.03). Additional E2 parameters were also evaluated: baseline E2, E2 on hCG day, E2 increase, and E2 fold change. Lower GDM rates were observed in women with baseline E2 above 31.50 pg/ml (13.51% vs. 19.42%, P <0.01), E2 on hCG day above 3794.50 pg/ml (12.26% vs. 19.32%, P < 0.001), and E2 increase above 3771.50 pg/ml (12.24% vs. 19.28%, P < 0.001). There were no significant differences in OHSS rates for these additional E2 parameters. After adjusting for confounders, lower E2/F ratio (OR: 1.626, 95% CI: 1.229-2.150, P <0.01), E2 on hCG day (OR: 1.511, 95% CI: 1.133-2.016, P = 0.01), and E2 increase (OR: 1.522, 95% CI: 1.141-2.031, P <0.01) were identified as risk factors for GDM.

Conclusion: This study demonstrates that an E2/F ratio over 246.03 pg/ml is significantly associated with a reduced risk of both GDM and OHSS in women undergoing fresh embryo transfer, highlighting the E2/F ratio as a superior predictive biomarker compared to other E2-related parameters.

Keywords: GDM; IVF; estradiol: follicle ratio; predictor; pregnancy outcomes.

MeSH terms

  • Adult
  • Biomarkers / blood
  • Chorionic Gonadotropin* / blood
  • Diabetes, Gestational* / diagnosis
  • Diabetes, Gestational* / epidemiology
  • Embryo Transfer* / methods
  • Estradiol* / blood
  • Female
  • Fertilization in Vitro / methods
  • Humans
  • Ovarian Hyperstimulation Syndrome / epidemiology
  • Ovulation Induction / adverse effects
  • Ovulation Induction / methods
  • Predictive Value of Tests
  • Pregnancy
  • Prognosis
  • Prospective Studies

Substances

  • Chorionic Gonadotropin
  • Estradiol
  • Biomarkers

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Hunan High-Level Talent Aggregation Project [2022RC4007, BH], Boehringer Ingelheim AG personal fund to BH, the Hunan Provincial Grant for Innovative Province Construction [2019SK4012, GL], and Deutschland-Stipendium der Charité Universitätsmedizin Berlin to YL and China Scholarship Council (202108430016) to HC, Research Grant of CITIC-Xiangya (YNXM-202304, 202217) to FG and HC respectively.