Ma HH, et al. - This research was designed to examine whether copeptin concentrations (measured at the first prenatal visit) were associated with risk of gestational diabetes mellitus (GDM). At the first prenatal visit, high copeptin concentrations were associated with increased risk of GDM. This could be useful in identifying women at risk of GDM for early prevention strategies.

• The authors included consecutive women who admitted to the obstetrics center of their hospital from July 2015 to June 2016.
• They collected and analyzed data for fasting plasma glucose and copeptin concentrations at the first prenatal visit and one-step GDM screening with 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation.
• Using univariate and multivariate regression analysis, the relationship between levels of copeptin and GDM were evaluated.

• Out of the 827 women, 101 developed GDM (12.2%).
• Across the copeptin quartiles, the GDM distribution ranged between 4.4% (first quartile) and 25.1% (fourth quartile).
• The unadjusted and adjusted risk of GDM increased by 1442% (odds ratio 15.42 [95% CI 3.35–54.25], P < 0.001) and 642% (7.42 [2.69–16.02], P < 0.001) respectively, for each 1 log-unit increase in plasma concentration of copeptin.
• The marker displayed prognostic information (GDM: OR for fourth quartile, 3.11 [95% CI 1.95–5.24; P = 0.001]) in a multivariate model using the fourth quartiles of copeptin vs. quartiles 1 through 3 together with the clinical variables.
• The net reclassification improvement statistic demonstrated that the addition of copeptin to established risk factors significantly increased the correct reclassification of GDM (P = 0.02).
• The integrated discrimination improvement statistic found that between women with GDM and without GDM (P = 0.01), the copeptin level significantly increased discrimination.