Predictive Value of First Trimester APRI Score and FIB-4 Index for Gestational Diabetes Mellitus
Objective: Inflammation, liver injury, and subclinical fibrotic processes secondary to insulin resistance are thought to play an important role in gestational diabetes mellitus (GDM). This study aimed to evaluate the predictive value of the aspartate aminotransferase–platelet ratio index (APRI) and fibrosis-4 (FIB-4) index, which reflect inflammatory status and hepatic involvement, for the prediction of GDM.
Methods: This retrospective study included 3,305 pregnant women who delivered at Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Training and Research Hospital between January 2020 and December 2024. Of these, 371 women were diagnosed with GDM, while 2,934 women with normal glucose tolerance constituted the control group. Oral glucose tolerance test results, APRI scores, and FIB-4 indices were compared between the groups.
Results: The median APRI score and FIB-4 index were significantly higher in the GDM group than in the control group (P<0.001 and P=0.027, respectively). An APRI score >0.22 predicted GDM with a sensitivity of 61.46% and a specificity of 66.02% (AUC=0.667, P<0.001), whereas a first-trimester FIB-4 index >0.53 showed a sensitivity of 66.31% and a specificity of 41.0% (AUC=0.535, P=0.027). ROC analysis demonstrated that first-trimester APRI had significantly greater predictive ability for GDM than FIB-4 (P<0.001). Correlation analysis revealed no significant associations between APRI and clinical parameters, while the FIB-4 score showed weak positive correlations with age and parity.
Conclusion: The present study suggests that both APRI score and FIB-4 index may serve as noninvasive biomarkers for the early prediction of GDM. Notably, the APRI score demonstrated superior predictive performance compared with FIB-4 index.
Keywords: Gestational Diabetes Mellitus, APRI Score, FIB-4 Index, Inflammation, Oral Glucose Tolerance Test
1. ElSayed NA, Aleppo G, Aroda VR, et al., on behalf of the American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S19-S40. doi: 10.2337/dc23-S002.
2. Mora-Ortiz M, Rivas-García L. Gestational Diabetes Mellitus: Unveiling Maternal Health Dynamics from Pregnancy Through Postpartum Perspectives. Open Res Eur. 2024;4:164. doi: 10.12688/openreseurope.18026.2.
3. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019;5(1):47. doi: 10.1038/s41572-019-0098-8.
4. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-1779. doi: 10.1016/S0140-6736(09)60731-5.
5. Wu P, Wang Y, Ye Y, et al. Liver biomarkers, lipid metabolites, and risk of gestational diabetes mellitus in a prospective study among Chinese pregnant women. BMC Med. 2023;21(1):150. doi: 10.1186/s12916-023-02818-6.
6. Firouzi F, Ramezani Tehrani F, Shaharki H, Mousavi M, Moradi N, Saei Ghare Naz M. First Trimester Hematological Indices in Gestational Diabetes Mellitus: A Meta-Analysis. J Endocr Soc. 2025;9(5):bvaf043. doi: 10.1210/jendso/bvaf043.
7. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357. doi: 10.1002/hep.29367.
8. Zhou BG, Xia JL, Jiang X, Ding YB, She Q. Non-alcoholic fatty liver disease and gestational diabetes mellitus: a bidirectional two-sample mendelian randomization study. BMC Endocr Disord. 2024;24(1):40. doi: 10.1186/s12902-024-01569-6.
9. İbanoğlu MC, Yılmaz Ergani S, Şahin B, Oncu HN, İskender C, Ustun Y. Does aspartate aminotransferase platelet ratio index predict gestational diabetes mellitus? A retrospective cohort study. Acta Medica. 2023;6(1):92-99. doi:10.53446/actamednicomedia.1230613.
10. Gezer M, Taşdemir Ü, Eyisoy ÖG, Yiğit S, Özdemir ME, Demirci O. Maternal liver fibrosis indices as predictors of adverse perinatal outcomes in patients with gestational diabetes mellitus. Acta Diabetol. 2025;62(12):2055-2062. doi:10.1007/s00592-025-02547-7.
11. Aktemur G, Tonyali NV, Çakır BT, et al. Liver fibrosis markers in gestational diabetes. Am J Reprod Immunol. 2025;94(2):e70136. doi: 10.1111/aji.70136
12. International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, 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):676-82. doi: 10.2337/dc09-1848.
13. Liu H, Zhang L, Cheng H, et al. The associations of maternal liver biomarkers in early pregnancy with the risk of gestational diabetes mellitus: a prospective cohort study and Mendelian randomization analysis. Front Endocrinol (Lausanne). 2024;15:1396347. doi: 10.3389/fendo.2024.1396347.
14. Donnelly SR, Hinkle SN, Rawal S, et al. Prospective study of gestational diabetes and fatty liver scores 9 to 16 years after pregnancy. J Diabetes. 2019;11(11):895-905. doi: 10.1111/1753-0407.12934.
15. Foo RX, Ma JJ, Du R, et al. Gestational diabetes mellitus and development of intergenerational non-alcoholic fatty liver disease (NAFLD) after delivery: a systematic review and meta-analysis. EClinicalMedicine. 2024;72:102609. doi: 10.1016/j.eclinm.2024.102609.
16. Phaloprakarn C, Sethasine S. Association between glucose intolerance and fatty liver disease in women with previous gestational diabetes mellitus in urban Thailand: a prospective cohort study. BMJ Open. 2025;15(5):e097114. doi: 10.1136/bmjopen-2024-097114.
17. Chai TY, George J, Pasupathy D, Cheung NW, Rudland VL. Metabolic fatty liver disease and GDM. Nutrients. 2025;17(10):1730. doi: 10.3390/nu17101730.
18. Li SM, Li GX, Fu DM, Wang Y, Dang LQ. Liver fibrosis evaluation by ARFI and APRI in chronic hepatitis C. World J Gastroenterol. 2014;20(28):9528-33. doi: 10.3748/wjg.v20.i28.9528.
19. Tolunay HE, Kahraman NÇ, Varlı EN, et al. First-trimester aspartate aminotransferase to platelet ratio index in predicting intrahepatic cholestasis in pregnancy and its relationship with bile acids: A pilot study. Eur J Obstet Gynecol Reprod Biol. 2021;256:114-117. doi: 10.1016/j.ejogrb.2020.11.014.
20. Cemortan M, Iliadi-Tulbure C, Sagaidac I, Cernetchi O. Assessment of aspartate aminotransferase to Platelet Ratio Index and Fibrosis-4 Index score on women with intrahepatic cholestasis of pregnancy. AJOG Glob Rep. 2024;4(2):100337. doi: 10.1016/j.xagr.2024.100337.
21. Şaşmaz Mİ, Ayvaz MA, Dülger AC, Kuday Kaykısız EK, Güven R. Aspartate-aminotransferase to platelet ratio index score for predicting HELLP syndrome. Am J Emerg Med. 2020;38(3):459-462. doi: 10.1016/j.ajem.2019.02.014.
22. Özer S, Güneş H, Özer A. FIB4 score is increased in severe preeclampsia. Turk J Biochem. 2024;49(1):56-63. doi:10.1515/tjb-2022-0214.
23. Lee SM, Kwak SH, Koo JN, et al. Non-alcoholic fatty liver disease in the first trimester and subsequent development of gestational diabetes mellitus. Diabetologia 2019;62(2):238-248. doi: 10.1007/s00125-018-4779-8.
24. Ajmera VH, Gunderson EP, VanWagner LB, Lewis CE, Carr JJ, Terrault NA. Gestational diabetes mellitus is strongly associated with Non-Alcoholic fatty liver disease. Am J Gastroenterol. 2016;111(5):658-664. doi: 10.1038/ajg.2016.57.
25. Liu H, Zhang L, Cheng H, et al. The associations of maternal liver biomarkers in early pregnancy with the risk of gestational diabetes mellitus: a prospective cohort study and Mendelian randomization analysis. Front Endocrinol (Lausanne) 2024;15:1396347. doi:10.3389/fendo.2024.1396347.
26. Durantaş H, Boz O, Karacalık Ünver C, et al. Effects of orlistat on APRI and FIB-4 scores in patients with obesity: a retrospective observational study. BMC Endocr Disord 2026;26(1):81. doi:10.1186/s12902-026-02196-z.
Copyright (c) 2026 The European Research Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Downloads
Article Information
- Article Type Research Article
- Submitted March 16, 2026
- Accepted May 3, 2026
- Published May 14, 2026
- Issue 2026: Online First
- Section Research Article
- Categories
