31 Aug Gestational Diabetes: Associated with Low Pre-Pregnancy Adiponectin Levels
MedicalResearch.com: What are the main findings of the study?
Dr. Hedderson: It is fascinating to discover that metabolic abnormalities appear to be present, even years before pregnancy, in a large proportion of women who develop gestational diabetes. The findings from this study emphasize the importance of the pre-pregnancy period in future pregnancy outcomes.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Hedderson: The magnitude of the findings were a surprise. Overweight or obese women with lower than average levels of adiponectin were found to be seven times more likely to develop the condition than women of average BMI with normal adiponectin levels. It is rare to find an association that strong. We also found that women who were normal weight but had lower than average levels of adiponectin had a 3.5 fold increased risk of GDM. This is important because although we know obesity is one of the strongest risk factors for GDM, less is known about risk factors among normal weight women who develop GDM. It was also surprising that the association between adiponectin and GDM risk was independent of other known risk factors for GDM, including measures of insulin resistance. This suggests that it may be acting through a unique mechanism.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Hedderson: I think clinicians need to be aware of the importance of the pre-pregnancy period. With the current obesity epidemic, more than 30% of women are entering pregnancy overweight or obese. We know know obesity is associated with several pregnancy complications, including gestational diabetes, and most women retain excess weight after pregnancy. There is a growing body of evidence to suggest that achieving a health body weight before pregnancy would reduce a number of pregnancy complications, including gestational diabetes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Hedderson: There is scientific evidence that weight loss and certain dietary factors may increase adiponectin levels. However, more research is needed to determine the best strategies to improve adiponectin levels. Lifestyle intervention studies designed to prevent diabetes by decreasing dietary fat intake and increasing physical activity have been shown to be extremely effective at reducing the risk of diabetes in at risk populations. It is likely that similar interventions in young, reproductive aged women would be effective at reducing gestational diabetes, but more studies are needed to confirm the effectiveness in younger populations.
Low Prepregnancy Adiponectin Concentrations Are Associated With a Marked Increase in Risk for Development of Gestational Diabetes Mellitus
Monique M. Hedderson, Jeanne Darbinian, Peter J. Havel, Charles P. Quesenberry, Sneha Sridhar, Samantha Ehrlich, and Assiamira Ferrara
Diabetes Care published ahead of print August 29, 2013, doi:10.2337/dc13-0389