Circulating B-type natriuretic peptide in women with and without recent gestational diabetes: The impact of current glucose intolerance.

Abstract

Circulating B-type natriuretic peptide, as measured by the N-terminal fragment of its prohormone (NT-proBNP), is inversely associated with incident type 2 diabetes (T2DM) but positively related to future cardiovascular disease (CVD). Recognizing that gestational diabetes (GDM) identifies women at future risk for both T2DM and CVD, we sought to determine whether gestational glucose tolerance relates to NT-proBNP in the years after delivery. Three hundred and forty women underwent a glucose challenge test (GCT) and an oral glucose tolerance test (OGTT) in pregnancy, yielding 4 gestational glucose tolerance groups: GDM (n=105); gestational impaired glucose tolerance (n=59); abnormal GCT with a normal OGTT (n=98); and normal GCT with normal OGTT (n=75). At 3-year postpartum, they underwent cardiometabolic characterization (including measurement of estimated glomerular filtration rate (eGFR), adiponectin and NT-proBNP) and repeated the OGTT, revealing 69 women with glucose intolerance (prediabetes/diabetes). At 3-year postpartum, serum NT-proBNP did not differ between the 4 original gestational glucose tolerance groups (P=.44), but instead progressively decreased across current glucose tolerance strata, from normal to prediabetes to diabetes (P=.006). Indeed, on logistic regression analysis, NT-proBNP emerged as a negative predictor of prediabetes/diabetes (OR=0.903, 95% CI 0.825-0.988, P=.026). On multiple linear regression analyses of NT-proBNP, the significant association with current glucose intolerance was ultimately attenuated in a fully adjusted model, revealing two independent determinants of NT-proBNP: eGFR (t=-2.71, P=.007) and adiponectin (t=2.44, P=.015). Serum NT-proBNP relates to current glucose intolerance, rather than preceding gestational dysglycaemia. Thus, the diabetic (rather than vascular) risk implications of NT-proBNP predominate in young women.