Abstract
Background/Aims Adiponectin is an adipocyte-derived polypeptide with insulin-sensitizing properties that has been prospectively linked to the development of type 2 diabetes. Adiponectin levels decrease during the course of normal pregnancy. It is unknown whether pre-pregnancy adiponectin levels are related to risk of gestational diabetes mellitus (GDM), a common pregnancy complication and strong predictor of type 2 diabetes. Our study assessed prospectively whether serum total and high molecular weight (HMW) adiponectin concentrations measured before pregnancy are associated with subsequent risk of GDM.
Methods We conducted a case-control study among normoglycemic women who took part in a multiphasic health checkup (MHC) exam at Kaiser Permanente Northern California between 1984–1996 and had a subsequent pregnancy before 2009 (255 GDM cases and 507 controls, matched on: year of exam, age at exam and age at pregnancy and number of intervening pregnancies). The MHC exam occurred on average 7 years before pregnancy.
Results Pre-pregnancy total adiponectin and HMW concentrations were lower in women who developed GDM than controls (7.7 vs. 10.6 and 2.8 vs. 3.9 μg/ml, respectively, P-values <0.001). Compared with women in the highest quartile of total adiponectin, women in the lowest quartile had an almost 4-fold increased risk of GDM after adjusting for insulin, hours since last food, race/ethnicity, family history of diabetes, education, BMI and parity (OR (95% CI): 3.83 (2.05–7.16)). Similar results were observed comparing the highest versus lowest quartile of HMW adiponectin (OR: 4.15 (2.20–7.83)).
Conclusions The risk of GDM is increased among women with lower pre-pregnancy levels of adiponectin, suggesting decreased insulin sensitivity is present years before pregnancy. Measuring adiponectin may help identify women at high risk for GDM.
