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Adiponectin, glucose changes in early pregnancy may predict gestational diabetes
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Women with a history of gestational diabetes who developed the condition with a subsequent pregnancy showed alterations in blood glucose, insulin and several key adipokines as early as 14 weeks’ gestation in the later pregnancy, according to findings published in Metabolism.
Women with a history of gestational diabetes have a high rate of recurrence, with 48% of subsequent pregnancies affected, Kym J. Guelfi, PhD, a senior lecturer in exercise physiology and biochemistry at the University of Western Australia School of Human Sciences, and colleagues wrote in the study background. The risk for gestational diabetes is further increased, they noted, in women with overweight and obesity.
“This risk may be related, at least in part, to immunomodulatory factors (adipokines) released from adipose tissue, which have been shown to increase systemic inflammation and contribute to insulin resistance,” the researchers wrote. “Many of these adipokines are produced in altered amounts in pregnancy and may be implicated in the development of glucose intolerance and [gestational diabetes].”
Guelfi and colleagues analyzed data from 123 women with a history of gestational diabetes in a previous pregnancy who participated in a randomized controlled trial involving a home-based exercise intervention (mean age, 34 years; mean baseline BMI, 26.1 kg/m²; 84% white). Researchers randomly assigned women between 12 to 14 weeks’ gestation to either a 14-week supervised exercise program (three sessions per week of stationary cycling until 28 weeks’ gestation) or a control group and analyzed blood samples collected at 14 and 28 weeks’ gestation. Primary outcome was a diagnosis of gestational diabetes, defined as a fasting blood glucose of at least 5.5 mmol/L or 2-hour oral glucose tolerance test of at least 8 mmol/L. Researchers compared the metabolic profiles of women who developed gestational diabetes with those who did not develop the condition at both 14 and 28 weeks’ gestation, assessing several adipokine concentrations, including fatty acid-binding protein 4 (FABP4), leptin, chemerin, adiponectin and resistin.
At 28 weeks’ gestation, 52 women (42%) were diagnosed with gestational diabetes based on the OGTT. These women were older than women who did not develop gestational diabetes (mean age, 34 years vs. 33 years); there were no between-group differences for BMI or ethnicity.
Researchers found that with advancing pregnancy, maternal adiponectin concentrations decreased, whereas serum leptin and resistin levels increased (P < .05).
In the 42% of women who developed gestational diabetes at 28 weeks’ gestation, fasting and postprandial glucose levels were already elevated by 14 weeks (P < .05), and serum adiponectin concentrations were lower (P < .05), according to researchers. Adiponectin remained lower at the time of gestational diabetes diagnosis (P < .05); there were no between-group differences for other adipokines at 14 or 28 weeks’ gestation. There were no between-group differences in HbA1c at 14 or 28 weeks’ gestation.
“We have found differences in the circulating concentrations of blood glucose, insulin and adiponectin concentrations as early as 14 weeks of pregnancy in women who go on to develop gestational diabetes, compared with those who avoid gestational diabetes recurrence,” the researchers wrote. “These findings suggest some prognostic utility of maternal adipokine profile and glucose tolerance testing in early pregnancy for women at high risk of gestational diabetes recurrence.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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