Abstract
BackgroundIn search of potential early biomarkers for timely prediction of gestational diabetes mellitus (GDM), we focused on afamin, a vitamin E–binding protein in human plasma.. Afamin plays a role in anti-apoptotic cellular processes related to oxidative stress and is associated with insulin resistance and other features of metabolic syndrome. During uncomplicated pregnancy its serum concentrations increase linearly. The aim of this study was to investigate the suitability of afamin as early marker for predicting GDM.MethodsIn a first-trimester cohort from a prospective observational study of adverse pregnancy outcomes we secondarily analyzed afamin concentrations in 59 patients diagnosed with GDM and 51 controls. Additionally, afamin concentrations were cross-sectionally examined in a mid-trimester cohort of 105 women and compared with results from a simultaneously performed oral glucose tolerance test (OGTT). Subgroup analysis comparing patients treated with either insulin (iGDM) or dietary intervention (dGDM) was performed in both cohorts. Patients were recruited at the University Hospital Essen, Germany, between 2003 and 2016.ResultsResults were adjusted for body-mass-index (BMI) and gestational age. First and mid-trimester cohorts yielded significantly elevated afamin concentrations in patients with pathological OGTT compared to patients without GDM (first trimester cohort: mean, 113.4 mg/l; 95% CI, 106.4–120.5 mg/l and 87.2 mg/l; 95% CI, 79.7–94.7 mg/l; mid-trimester cohort: mean, 182.9 mg/l; 95% CI, 169.6–196.2 mg/l and 157.3 mg/l; 95% CI, 149.1–165.4 mg/l, respectively). In the first-trimester cohort, patients developing iGDM later in pregnancy presented with significantly higher afamin concentrations compared to patients developing dGDM and compared to patients without GDM. In the mid-trimester cohort, mean concentrations of afamin differed significantly between patients with dGDM compared to controls and between patients with iGDM and controls. Patients with iGDM showed only slightly higher afamin levels compared to patients with dGDM.ConclusionAfamin may serve as a new early biomarker for pathological glucose metabolism during pregnancy. Further research is needed to determine afamin’s concentrations during pregnancy, its predictive value for early detection of pregnancies at high risk to develop GDM and its diagnostic role during the second trimester.
Highlights
In search of potential early biomarkers for timely prediction of gestational diabetes mellitus (GDM), we focused on afamin, a vitamin E–binding protein in human plasma
In a secondary analysis of samples which were taken from a prospective observational study with the aim to predict adverse pregnancy outcomes, we examined the association between serum afamin concentrations during the first trimester and the subsequent development of Gestational diabetes mellitus (GDM) during the ongoing pregnancy
Since afamin levels depend on BMI and gestational age, the subsequent results comparing afamin levels between controls, Insulin dependent gestational diabetes mellitus (iGDM) and Gestational diabetes mellitus treated with diet (dGDM) patients, were adjusted for BMI and gestational age: Serum afamin concentrations measured during the first trimester were significantly higher among patients with GDM than among patients without GDM diagnosis later in their pregnancy
Summary
In search of potential early biomarkers for timely prediction of gestational diabetes mellitus (GDM), we focused on afamin, a vitamin E–binding protein in human plasma. Gestational diabetes mellitus (GDM) is a common disorder that occurs in approximately 7% to 14% of pregnancies [1]. As shown by the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) trial, pathological findings from the 75-g oral glucose tolerance test (OGTT) are strongly associated with adverse pregnancy outcome [4, 5]. Some studies have demonstrated a benefit for the mother and the baby if diabetes is screened, diagnosed, and treated during pregnancy [6, 7]. An important finding in Landon’s [6] interventional trial involving patients with mild GDM was a reduction in the risk of cesarean section and of preeclampsia if GDM was screened, diagnosed, and treated. The exact and timely diagnosis of GDM allows successful interventions and improves pregnancy outcomes
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