Abstract: Objective To investigate the key risk predictors for the development of gestational diabetes mellitus (GDM) in pregnant women with chronic hepatitis B virus (HBV), as well as its impact on adverse pregnancy outcomes, in order to provide a basis for early identification of high-risk populations and improvement of maternal and fetal outcomes. Methods A retrospective analysis was conducted on 80 pregnant women with chronic HBV infection and GDM (HBV+GDM group) who delivered in our hospital between January 2022 and December 2024, serving as the case group. A control group (pure HBV group) of 80 pregnant women with chronic HBV infection but without GDM during the same period was matched at 1∶1 ratio. Baseline characteristics, liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), albumin (Alb), prealbumin (PAB), cholinesterase (ChE)], bilirubin metabolism indicators [total bilirubin (TBil), direct bilirubin (DBil)], glucose metabolism, and renal function [fasting blood glucose, uric acid (UA), creatinine (Cr)] were compared between the two groups. Independent predictors of GDM in HBV-infected pregnant women were determined through multivariate logistic regression, with receiver operating characteristic (ROC) curve analysis evaluating their predictive efficacy. Follow-up was conducted until postpartum discharge to compare adverse pregnancy outcomes between the two groups. Results No significant difference was observed between groups regarding age, gravidity and parity, pre-pregnancy BMI, family history of diabetes, AST, ALP, GGT, Alb, ChE, TBil, DBil, or Cr levels (P<0.05). Levels of fasting blood glucose [(5.14±0.64) mmol/L], ALT [(19.90±4.46) U/L], LDH [(178.45±30.58) U/L], PAB [(258.33±42.19) mg/L], and UA [(275.70±48.43) μmol/L] in the HBV+GDM group were higher than those in the HBV group [(4.72±0.48) mmol/L, (18.21±3.56) U/L, (165.60±28.18) U/L, (235.70±45.28) mg/L, (248.16±39.31) μmol/L] (P<0.05). Multivariate logistic regression analysis showed that elevated fasting blood glucose (OR=4.334), ALT (OR=1.136), LDH (OR=1.014), PAB (OR=1.014), and UA (OR=1.018) were independent risk factors for GDM in pregnant women with chronic HBV infection (P<0.05). All five independent risk factors demonstrated some predictive ability for GDM occurrence (AUC<0.50 for all). Among them, fasting blood glucose had the highest predictive efficacy (AUC=0.691), followed by UA (AUC=0.676) and PAB (AUC=0.640). The combined prediction model using these five factors had an AUC of 0.825, with a sensitivity of 66.2% and specificity of 88.7%, indicating relatively high predictive efficacy. The overall incidence of adverse pregnancy outcomes was higher in the HBV+GDM group than in the HBV group (P<0.05). Conclusion In pregnant women with chronic HBV infection, early pregnancy fasting blood glucose, ALT, LDH, PAB, and UA are independent risk factors for GDM. The combined prediction model constructed from these factors exhibited excellent discriminative ability. Once GDM is superimposed on HBV infection, it significantly increases the risk of adverse pregnancy outcomes. It is recommended to implement early intensive monitoring and intervention for HBV-infected pregnant women who exhibit these risk factors.

Key words: Gestational diabetes mellitus, Hepatitis B virus, Risk factors, Prediction model, Pregnancy outcome