Are third-trimester adipokines associated with higher metabolic risk among women with gestational diabetes?
Résumé
Aim. This study aimed to determine whether third-trimester adipokines during gestational diabetes (GDM) are associated with higher metabolic risk.
Methods. A total of 221 women with GDM (according to IADPSG criteria) were enrolled between 2011/11 and 2013/6 into a prospective observational study (IMAGE), and categorized as having elevated fasting blood glucose (FBG) or impaired fasting glucose (IFG, n=36) if levels were >= 92 mg/dL during a 75-g oral glucose tolerance test (OGTT), impaired glucose tolerance (IGT, n= 116) if FBG was <92 mg/dL but with elevated 1-h or 2-h OGTT values, or impaired fasting and stimulated blood glucose (IFSG, n=69) if both FBG was >= 92 mg/dL and 1-h or 2-h OGTT values were elevated.
Results. - Pre-gestational body mass index (BMI) was higher in women with IFG or IFSG compared with JOT (P <0.001), as were leptin levels in women with IFG vs IGT [134.7 (10.5-119.7) vs 26.6(3.56-79.4) ng/L; P =0.008]. HOMA2-IR scores were higher in Women with IFG or IFSG vs IGT (1.87 +/- 1.2 or 1.72 +/- 0.9 vs 1.18 +/- 0.8, respectively; P <0.001). Also, those with IFSG vs those with IGT had significantly lower HOMA2-B scores (111.4 +/- 41.3 vs 127.1 +/- 61.6, respectively; P < 0.05) and adiponectin levels [5.00 (1.11-11.3) vs 6.19 (2.11-17.7) mu g/mL; P< 0.001], and higher levels of IL-6 [1.14 (0.33-20.0) vs 0.90 (0.31-19.0); P =0.012] and TNF-alpha [0.99 (0.50-10.5) vs 0.84 (0.45-11.5) pg/mL; P = 0.003]. After adjusting for age, parity, and pre-gestational and gestational BMI, the difference in adiponectin levels remained significant..
Conclusion. Diagnosing GDM by IADSPG criteria results in a wide range of heterogeneity. Our study has indicated that adipokine levels in addition to FBG may help to select women at high metabolic risk for appropriate monitoring and post-delivery interventions (ClinicalTrials.gov number NCP02133729).