Abstract: Objective: To investigate the prediction of gestational diabetes mellitus (GDM) by serum glycohemoglobin (HbA1c) combined with pregnancy-associated plasma protein A (PAPP-A) in early pregnancy. Methods: The pregnant women were included from December 1, 2018 to July 30, 2019. Clinical data, fasting plasma glucose (FPG)，HbA1c and PAPP-A median multiple of the median (MoM) were collected in early pregnancy (11 to 13+6 weeks). Based on a 75 g oral glucose tolerance test (OGTT) at 24 to 28 weeks, the pregnant women were divided into the study group and the control group. The optimal cutoff value of GDM was predicted by the statistical analysis, so as to get an optimal scheme to predict GDM in early pregnancy. Results: Multivariate logistic regression analysis showed that the independent risk-factors for GDM could include the high levels of FPG and HbA1c，low level of PAPP-A，pregnancy with assisted reproduction technology, family history of diabetes，and overweight or obesity in early pregnancy. The risk of GDM in the women with the family history of diabetes or in those pregnanct women with assisted reproduction technology was significantly increased (OR were 7.206 and 47.512, both P＜0.001). Analysis of receiver operating characteristic (ROC) curves and area under the curve (AUC) as different predictive indicators showed that the PAPP-A MoM combined with HbA1c and FPG had the highest AUC (0.728)，and there after the PAPP-A MoM combined with HbA1c (0.721) and the HbA1c combined with FPG (0.717), were both larger than HbA1c (0.707) and FPG (0.647) . The single AUC of PAPP-A MoM (0.380) was meaningless for the diagnosis of GDM. Conclusions: The combined detection of HbA1c and PAPP-A MoM can be recommended for those pregnancy women with high-risk factors to predict GDM in the early pregnancy.

Key words: Diabetes, gestational;, Hemoglobin A, glycosylated, Pregnancy-associated plasma protein-A;, Pregnancy trimester, first