Early markers of gestational diabetes mellitus: what we know and which way forward?

Jelena Omazić,Marta Kadivnik,Vedrana Ivić,Barbara Viljetić,Jasenka Wagner,Andrijana Müller,Lada Zibar

doi:10.11613/bm.2021.030502

Abstract

Women’s metabolism during pregnancy undergoes numerous changes that can lead to gestational diabetes mellitus (GDM). The cause and pathogenesis of GDM, a heterogeneous disease, are not completely clear, but GDM is increasing in prevalence and is associated with the modern lifestyle. Most diagnoses of GDM are made via the guidelines from the International Association of Diabetes and Pregnancy Study Groups (IADSPG), which involve an oral glucose tolerance test (OGTT) between 24 and 28 weeks of pregnancy. Diagnosis in this stage of pregnancy can lead to short- and long-term implications for the mother and child. Therefore, there is an urgent need for earlier GDM markers in order to enable prevention and earlier treatment. Routine GDM biomarkers (plasma glucose, insulin, C-peptide, homeostatic model assessment of insulin resistance, and sex hormone-binding globulin) can differentiate between healthy pregnant women and those with GDM but are not suitable for early GDM diagnosis. In this article, we present an overview of the potential early biomarkers for GDM that have been investigated recently. We also present our view of future developments in the laboratory diagnosis of GDM.

Highlights

During pregnancy, women’s metabolism undergoes numerous changes with respect to carbohydrates, fats and proteins in order to provide the nutrients and oxygen needed for foetal growth, and to fill the extra energy stores required for delivery and lactation [1]
Gestational diabetes mellitus is an independent type of diabetes defined as glucose intolerance, with first recognition arising during pregnancy and resolving after pregnancy
Several clinical studies using liquid chromatography-mass spectrometry (LC-MS) and targeted nuclear magnetic resonance (NMR) approach have shown these amino acids present at higher concentrations in pregnant women with gestational diabetes mellitus (GDM) compared to healthy pregnant women, and they increase in the first trimester, so they can be counted as predictive biomarkers of GDM [37,38]

Summary

Introduction

Women’s metabolism undergoes numerous changes with respect to carbohydrates, fats and proteins in order to provide the nutrients and oxygen needed for foetal growth, and to fill the extra energy stores required for delivery and lactation [1]. Major changes in any of these metabolic pathways can lead to gestational diabetes mellitus (GDM). Gestational diabetes mellitus is a pathophysiological state in which there is insufficient insulin available to maintain glucose concentrations in normal range, and hyperglycaemia occurs. Glucose control in pregnancy depends on ß-cell insulin secretion, the insulin clearance required to maintain the balance of hormonal changes in pregnancy, and insulin actions in the liver, muscles and tissues. Gestational diabetes mellitus complications involve intrauterine metabolic alterations in infants, and impact foetal programing, with long-term consequences later in life [13]. Gestational diabetes mellitus has short- and long-term implications for the mother as well. The long-term implications are associated with recurrent GDM in subsequent pregnancies, T2DM, and cardiovascular diseases later in life. Any method that is inexpensive, readily available, automated, and provides results quickly would be welcomed, as would the derivation of biomarkers via minimally invasive methods

Methods

Findings

Conclusion