

WHO diagnostic criteria for hyperglycemia and GDM (2006)

Many studies have shown that plasma adiponectin concentration is negatively correlated with body mass index (BMI) and accordingly, lower in obese than in lean subjects (Ouchi et al., 1999; Hotta et al., 2000; Pena et al., 2009). Furthermore, scientists extended these finding by demonstrating that plasma adiponectin concentrations are inversely related to percentage of body fat, a direct measure of adiposity. And that is consistent across different ethnic groups. These results thus confirm that adiponectin is the main adipose-specific protein known to date that despite its excusive production in white adipose tissue, is negatively regulated in obesity (Hu et al., 1996; Weyer et al., 2001; Statnick et al., 2000). These scientific data suggest that adiponectin may have a role in the pathogenesis of obesity. As obesity is a predisposing factor for the development of diabetes mellitus in general and GDM in specific, this might explain the indirect involvement of a decreased adiponectin in the pathogenesis of diabetes mellitus. It has also been shown that in pregnant women there is a decrease in adiponectin which is associated with an increase in insulin resistance in the third trimester and a further decrease in women with IGT or GDM compared to pregnant women with normal glucose tolerance test, even after adjustment for varying degree of adiposity. Hypoadiponectinemia was also found in women with GDM independently of 100 Gestational Diabetes their body fat mass compared to women with normal glucose tolerance during and after pregnancy (Yamauchi et al., 2003; Weyer et al., 2001; Kadowaki & Yamaushi, 2005). On experimental animal studies, it was shown that adiponectin causes glucose-lowering effects and ameliorates insulin resistance in mice (Yamauchi et al., 2003b). Thus, decreased plasma adiponectin concentrations (hypoadiponectinemia) could be involved in the pathophysiology of pregnancy-driven insulin resistance and in the pathogenesis of GDM and Diabetes mellitus type 2 (DM2)