Circulating adipokines and mRNA expression in adipose tissue and the placenta in women with gestational diabetes mellitus Maternal and neonatal omentin-1 levels in gestational diabetes Prevention of gestational diabetes through lifestyle intervention: study design and methods of a Finnish randomized controlled multicenter trial (RADIEL) Prediction of gestational diabetes in obese pregnant women from the UK Pregnancies Better Eating and Activity (UPBEAT) pilot trial. SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women Low level of Nesfatin-1 is associated with gestational diabetes mellitus Serum chemerin level during the first trimester of pregnancy and the risk of gestational diabetes mellitus Decreased plasma chemerin levels in women with gestational diabetes mellitus. Are adipokines associated with gestational diabetes mellitus? The association between adipocytokines and glycemic control in women with gestational diabetes mellitus The impact of risk factors and more stringent diagnostic criteria of gestational diabetes on outcomes in central European women.
HighlightsChemerin and leptin are increased , omentin‐1 and visfatin are decreased in at term GDM‐obese women .  Chemerin and omentin‐1 are expressed mainly by the maternal VAT . Leptin is expressed mainly in maternal SAT.Circulating chemerin and leptin in at term pregnancy correlate with BMI and HOMA‐IR.Chemerin and leptin could contribute to insulin resistance and low grade inflammation that characterizes GDM women complicated by obesity . Weight control during pregnancy is necessary to avoid adverse metabolic complications for the mother and the offspring . & NA ; Maternal adipose tissue and the placenta secrete various molecules commonly called adipokines such as chemerin , omentin‐1 , visfatin , adiponectin , and leptin that are important players in the pathogenesis of insulin resistance . Gestational diabetes mellitus ( GDM ) is defined as a state of glucose intolerance characterized by & bgr;‐cell dysfunction and insulin resistance . To examine whether circulating adipokines and their mRNA expression in the adipose tissue and the placenta are altered in GDM pregnancy , we compared 15 GDM women [ obese ( BMI > 30 ) and non‐obese ( BMI < 30 ) ] to 23 NGT ( normal glucose tolerance ) women [ obese and non‐obese ] , at the time of the Cesarean section .  Circulating chemerin and leptin were higher ( p = 0.009 and p = 0.005 , respectively ) and circulating omentin‐1 , visfatin , as well as the adiponectin/leptin ratio were lower ( p = 0.039 , p = 0.007 and p = 0.011 , respectively ) in GDM‐obese compared to NGT‐non‐obese women . Chemerin and leptin correlated positively with BMI and HOMA‐IR and omentin‐1 correlated negatively with BMI . Serum TNF‐&agr ; was significantly elevated in all obese compared to non‐obese pregnant women and correlated positively with BMI . Adiponectin levels were reduced ‐although not significantly‐ in GDM‐ and NGT‐obese women compared to their non‐obese counterparts . Resistin , RPB4 and IL‐6 levels did not differ significantly between groups . Chemerin mRNA expression in subcutaneous adipose tissue ( SAT ) and visceral adipose tissue ( VAT ) was significantly higher compared to placenta in all women ( 6‐to 24‐times , p < 0.05 ) . Chemerin‐VAT mRNA expression in GDM‐obese tended to be significantly higher compared to NGT‐non‐obese women ( 3‐times , p = 0.005 ) . Omentin‐1 mRNA expression was significantly higher in VAT compared to SAT ( 50‐ to 100‐times , p < 0.01 ) and its expression in placenta was negligible in all women . Although , leptin was expressed significantly higher in SAT compared to VAT and the placenta in all women ( 5‐ to 46‐times , p < 0.05 ) , only its mRNA expression in VAT of obese ( GDM and NGT ) differed significantly when compared to NGT‐non‐obese women ( 3‐times higher , p < 0.02 ) . Visfatin mRNA expression was comparable in all tissues . In conclusion , chemerin and leptin are elevated and omentin‐1 and visfatin levels are decreased in GDM women complicated by obesity . This finding together with the positive association of chemerin and leptin with markers of insulin resistance , suggests that these adipokines and more especially chemerin and leptin accompanied by their adipose tissue expression could contribute to the increased insulin resistance and low grade inflammation that characterizes GDM‐obese women Purpose To evaluate the effect of gestational diabetes on omentin-1 in maternal and cord plasma . As a potent mediator of insulin resistance , Omentin-1 , an adipokine derived from human adipose and placental tissue , may be an important player in the pathophysiology of gestational diabetes . Methods This was a prospect i ve case – control study . The study included 96 women with gestational diabetes and 96 pregnant women without .  Omentin-1  was measured at the time of the oral glucose tolerance test , at 32 weeks in maternal plasma and right after delivery in umbilical cord blood by ELISA assay . Results Over a period of 2 years , 200 patients were enrolled . Omentin-1 levels did not significantly differ between both groups throughout the pregnancy : omentin-1 levels were 157 ± 83 ng/ml in women with gestational diabetes and 158 ± 93 ng/ml in women without gestational diabetes ( p = 0.94 ) at time of the oral glucose tolerance test and 118 ± 77 ng/ml in women with diabetes and 150 ± 89 ng/ml in women without ( p = 0.12 ) at 32 weeks , respectively . Both groups showed a decrease in omentin-1 levels throughout pregnancy , with a more pronounced decrease in diabetic women ( 13 ± 53 versus 4 ± 48 ng/ml ; p = 0.5 ) . Neonatal omentin-1 levels were significantly lower in offspring of diabetic mothers : 106 ± 61 versus 134 ± 45 ng/ml ( p = 0.03 ) . Conclusions There was no significant difference in omentin-1 levels between healthy and diabetic mothers throughout the pregnancy . However , we found significantly lower omentin-1 levels in offspring of diabetic mothers . This may indicate a risk for the development of insulin resistance in later life Background Maternal overweight , obesity and consequently the incidence of gestational diabetes are increasing rapidly worldwide . The objective of the study was to assess the efficacy and cost-effectiveness of a combined diet and physical activity intervention implemented before , during and after pregnancy in a primary health care setting for preventing gestational diabetes , later type 2 diabetes and other metabolic consequences . Methods RADIEL is a r and omized controlled multi-center intervention trial in women at high risk for diabetes ( a previous history of gestational diabetes or prepregnancy BMI ≥30 kg/m2 ) . Participants planning pregnancy or in the first half of pregnancy were parallel-group r and omized into an intervention arm which received lifestyle counseling and a control arm which received usual care given at their local antenatal clinics . All participants visited a study nurse every three months before and during pregnancy , and at 6 weeks , 6 and 12 months postpartum . Measurements and laboratory tests were performed on all participants with special focus on dietary and exercise habits and metabolic markers . Of the 728 women [ mean age 32.5 years ( SD 4.7 ) ; median parity 1 ( range 0 - 9 ) ] considered to be eligible for the study 235 were non-pregnant and 493 pregnant [ mean gestational age 13 ( range 6 to 18 ) weeks ] at the time of enrollment . The proportion of nulliparous women was 29.8 % ( n = 217 ) . Out of all participants , 79.6 % of the non-pregnant and 40.4 % of the pregnant women had previous gestational diabetes and 20.4 % of the non-pregnant and 59.6 % of the pregnant women were recruited because of a prepregnancy BMI  ≥30 kg/m2 . Mean BMI at first visit was 30.1 kg/m2 ( SD 6.2 ) in the non-pregnant and 32.7 kg/m2 ( SD 5.6 ) in the pregnant group . Discussion To our knowledge , this is the first r and omized lifestyle intervention trial , which includes , besides the pregnancy period , both the prepregnancy and the postpartum period . This study design also provides an opportunity to focus upon the health of the next generation . The study is expected to produce novel information on the optimal timing and setting of interventions and for allocating re sources to prevent obesity and diabetes in women of reproductive age . Trial registration Clinical trials.gov Identifier : AIM To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester . METHODS A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity  were studied . Blood sample s were obtained at recruitment ( 15⁺⁰-17⁺⁶ weeks ' gestation ) and demographic , clinical history and anthropometric measures recorded . The biomarkers analysed were plasma lipids ( HDL cholesterol , LDL cholesterol , triglycerides ) , high-sensitivity C-reactive protein , alanine transaminase , aspartate transaminase , ferritin , fructosamine , insulin , adiponectin , tissue plasminogen activator , interleukin-6 , visfatin and leptin . Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model . RESULTS Of the 106 participants included in the analysis , 29 ( 27.4 % ) developed gestational diabetes . Participants with gestational diabetes were older ( P = 0.002 ) , more often of parity ≥ 2 , had higher systolic ( P = 0.02 ) and diastolic blood pressure ( P = 0.02 ) and were more likely to be black ( P = 0.009 ) . Amongst the blood biomarkers measured , plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models ( P = 0.002 ) . The area under the receiver-operating curve for clinical factors alone ( 0.760 ) increased significantly ( area under the curve 0.834 , chi-square statistic ( 1 ) = 4.00 , P = 0.046 ) with the addition of adiponectin . CONCLUSIONS A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes . Validation in a large prospect i ve study is required to determine the usefulness of this algorithm in clinical practice Background Obesity is increasing in the child-bearing population as are the rates of gestational diabetes . Gestational diabetes is associated with higher rates of Cesarean Section for the mother and increased risks of macrosomia , higher body fat mass , respiratory distress and hypoglycemia for the infant . Prevention of gestational diabetes through life style intervention has proven to be difficult . A Finnish study showed that ingestion of specific probiotics altered the composition of the gut microbiome and thereby metabolism from early gestation and decreased rates of gestational diabetes in normal weight women . In SPRING ( the Study of Probiotics IN the prevention of Gestational diabetes ) , the effectiveness of probiotics ingestion for the prevention of gestational diabetes will be assessed in overweight and obese women . Methods / design SPRING is a multi-center , prospect i ve , double-blind r and omized controlled trial run at two tertiary maternity hospitals in Brisbane , Australia . Five hundred and forty ( 540 ) women with a BMI > 25.0 kg/m2 will be recruited over 2 years and receive either probiotics or placebo capsules from 16 weeks gestation until delivery . The probiotics capsules contain > 1x109 cfu each of Lactobacillus rhamnosus GG and Bifidobacterium lactis BB-12 per capsule . The primary outcome is diagnosis of gestational diabetes at 28 weeks gestation . Secondary outcomes include rates of other pregnancy complications , gestational weight gain , mode of delivery , change in gut microbiome , preterm birth , macrosomia , and infant body composition . The trial has 80 % power at a 5 % 2-sided significance level to detect a > 50 % change in the rates of gestational diabetes in this high-risk group of pregnant women . Discussion SPRING will show if probiotics can be used as an easily implementable method of preventing gestational diabetes in the high-risk group of overweight and obese pregnant women Abstract Introduction : Gestational diabetes mellitus ( GDM ) occurs in ∼10–25 % of pregnancies . Nesfatin-1 , plays a role in carbohydrate metabolism by inhibiting glucagon secretion , besides has a glucose-dependent insulinotropic effect . Explanation of the GDM pathogenesis is important due to preventing gestational complications . We aim ed to investigate relationship between GDM and Nesfatin-1 . Material and methods : Seventy-nine pregnant subjects were r and omly allocated to either GDM group ( GDG , n = 38 ) or control group ( CG , n = 41 ) . For GDM diagnosis , 50 and 100 g oral glucose tolerance test ( OGTT ) were used . Nesfatin-1 , insulin and other parameters were measured for all subjects . The homeostasis model assessment -insulin resistance ( HOMA-IR ) was calculated . Results : Nesfatin-1 was found lower and insulin was found higher in GDG than CG . Negative correlation has been founded between Nesfatin-1 with weight , BMI , fasting glucose , serum glucose level at first hour of the 50 g OGTT and HOMA-IR . Conclusion : In this study , patients with GDM had lower Nesfatin-1 levels than without GDM . Therefore , when the Nesfatin-1 effects on the GDM pathogenesis is clear , it may be contributed to diagnosis and treatment of the GDM Abstract Objective : To investigate the association between chemerin level in the first trimester of pregnancy and the risk of gestational diabetes mellitus . Methods : The blood sample s of 212 women at 8–12 weeks of gestation were collected . After screening for gestational diabetes mellitus ( GDM ) , 19 women with GDM and 20 women r and omly selected from 144 women with normal glucose tolerance ( NGT ) were included in the study .  Blood sample s were collected from these women .  Triglycerides , glucose , total cholesterol , and HDL cholesterol , LDL cholesterol , insulin and chemerin were measured . Gestational weight gain and body mass index was assessed . Results : Serum levels of chemerin were significantly elevated during late gestation , and the risk of GDM was positively associated with maternal serum chemerin in the first trimester . Conclusion : Serum chemerin level during the first trimester of pregnancy has the potential to predict risk of GDM AIMS To evaluate fasting and post-pr and ial serum chemerin levels in pregnant women with and without gestational diabetes , and again following delivery when normal glucose homeostasis is re-established . METHODS  Chemerin levels were measured in serum from nine women with gestational diabetes , and from eight age- and BMI -matched pregnant women with normal glucose tolerance during two meal tests : in the third trimester and 3 - 4 months post partum . All women with gestational diabetes re-established normal glucose tolerance after delivery . RESULTS Meal intake did not affect serum chemerin levels . The group with gestational diabetes had lower mean serum chemerin levels during the third trimester compared with the group with normal glucose tolerance ( 28 ± 1.3 vs. 88 ± 3.5 ng/ml , P < 0.0001 ) . In the group with normal glucose tolerance , mean serum chemerin levels decreased significantly post partum to 57 ± 2.8 ng/ml ( P = 0.0001 ) , but remained significantly ( P = 0.0003 ) higher than post-partum levels in the group with gestational diabetes ( 31 ± 1.9 ng/ml ) , which did not differ significantly from third trimester levels ( P = 0.31 ) . CONCLUSIONS Normal pregnancy is associated with increased circulating chemerin levels , which may act to reduce pregnancy-induced insulin resistance and prevent glucose intolerance . Women with gestational diabetes , however , have severely reduced chemerin levels that remain low after delivery , which may contribute to the insulin resistance , glucose intolerance and high type 2 diabetes risk associated with gestational diabetes OBJECTIVE To investigate the association of maternal serum levels of chemerin , retinol binding protein-4 ( RBP-4 ) , and visfatin with gestational diabetes mellitus ( GDM ) . MATERIAL AND METHODS 158 pregnant women were screened between 24 and 28 weeks of gestation . They were divided into two groups : GDM group ( n=76 ) and control group ( n=82 ) . Maternal serum concentrations of chemerin , RBP-4 , visfatin , insulin , and homeostasis model assessment -insulin resistance ( HOMA-IR ) were assessed . RESULTS There were no differences in age and gestational age between the GDM group and the control group ( p=0.058 and p=0.820 , respectively ) . Body mass index ( BMI ) at 24 to 28 weeks of gestation was higher in the GDM group ( p<0.001 ) . The serum concentrations of RBP-4 , chemerin , and visfatin did not demonstrate significant differences between the GDM and control groups ( p=0.871 , p=0.100 , and p=0.886 , respectively ) . Significant differences in serum level of insulin and HOMA-IR were found between the GDM and control groups ( 14.94 vs 9.87 , p<0.001 and 3.73 vs 1.77 , p<0.001 , respectively ) . Correlation analyses of chemerin , RBP-4 , visfatin , insulin , and HOMA-IR in both groups revealed a weak degree of positive correlation between RBP-4 and chemerin ( Spearman r=0.251 , p=0.026 ) and a strong positive correlation between maternal insulin and HOMA ( Spearman r=0.868 , p<0.001 ) . CONCLUSION No differences were found in serum chemerin , RBP-4 , and visfatin between pregnant women with GDM and healthy pregnant women . Further prospect i ve studies will be essential to eluci date the contribution of adipokines to GDM and the positive correlation between maternal RBP-4 and chemerin Abstract Objective : To evaluate the relationship between adipocytokines and glycemic control . Study design : Prospect i ve observational trial of gestations with gestational diabetes mellitus ( GDM ) .  Fasting glucose ( FG ) , insulin , adiponectin , leptin , chemerin , retinol-binding protein 4 ( RBP-4 ) , osteocalcin , and resistin were measured . HomeOstasis model assessment of insulin resistance ( HOMA-IR ) and QUantitative insulin sensitivity ChecK Index ( QUICKI ) were calculated . Women who required medications for glycemic control were compared to women using nutritional therapy only . Results : Overall , 75 women were included −26 ( 34.7 % ) required medications to achieve good glycemic control . Factors associated with poor control are as follows : low resistin ( aOR 0.84 ) , HOMA-IR ( aOR 1.96 ) , QUICKI ( aOR 0.62 ) , first trimester FG ( aOR 1.43 ) , and maternal age ( aOR 1.26 ) . HOMA-IR and QUICKI performed highest for prediction . Resistin , first trimester FG , maternal age , and QUICKI had an AUC of 0.878 , sensitivity and specificity of 87.5 % for the prediction of the need for medications . Conclusions : Low resistin is associated with poor control . A model utilizing maternal age , first trimester fasting glucose , and first visit QUICKI yields good predictability OBJECTIVES In the face of the ongoing discussion on the criteria for the diagnosis of gestational diabetes ( GDM ) , we aim ed to examine whether the criteria of the Fourth International Workshop Conference of GDM ( WC ) select women and children at risk better than the World Health Organization ( WHO ) criteria . DESIGN AND SETTING This was a prospect i ve longitudinal open study in five tertiary care centers in Austria . PATIENTS AND OUTCOME MEASURES The impact of risk factors , different thresholds ( WC vs. WHO ) , and numbers of abnormal glucose values ( WC ) during the 2-h , 75-g oral glucose tolerance test on fetal/neonatal complications and maternal postpartum glucose tolerance was studied in 1466 pregnant women . Women were treated if at least one value according to the WC ( GDM-WC1 ) was met or exceeded . RESULTS Forty-six percent of all women had GDM-WC1 , whereas 29 % had GDM-WHO , and 21 % of all women had two or three abnormal values according to WC criteria ( GDM-WC2 ) . Eighty-five percent of the GDM-WHO were also identified by GDM-WC1 . Previous GDM [ odds ratio ( OR ) 2.9 ] , glucosuria ( OR 2.4 ) , preconceptual overweight/obesity ( OR 2.3 ) , age 30 yr or older ( OR 1.9 ) , and large-for-gestational age ( LGA ) fetus ( OR 1.8 ) were the best independent predictors of the occurrence of GDM . Previous GDM ( OR 4.4 ) and overweight/obesity ( OR 4.0 ) also independently predicted diabetes postpartum . GDM-WC1 had a higher rate of obstetrical complications ( LGA neonates , neonatal hypoglycemia , cesarean sections ; P < 0.001 ) and impaired postpartum glucose tolerance ( P < 0.0001 ) than GDM-WHO . CONCLUSION These results suggest the use of more stringent WC criteria for the diagnosis of GDM with the initiation of therapy in case of one fasting or stimulated abnormal glucose value because these criteria detected more LGA neonates with hypoglycemia and mothers with impaired postpartum glucose metabolism than the WHO criteria
Objective To determine the difference of serum levels of 10 adipokines ( apelin , chemerin , fatty acid-binding protein-4 , fibroblast growth factor-21 , monocyte chemoattractant protein-1 , nesfatin-1 , omentin-1 , resistin , vaspin , and visfatin ) among women with gestational diabetes and healthy pregnant controls .