Abstract
BackgroundTo assess the association between plasma retinol-binding protein 4 (RBP4) levels both in the first trimester and second trimester and risk of gestational diabetes mellitus (GDM).MethodsPlasma RBP4 levels and insulin were measured among 135 GDM cases and 135 controls nested within the Peking University Birth Cohort in Tongzhou. Multivariable linear regression analysis was conducted to assess the influence of RBP4 levels on insulin resistance. Conditional logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval (CI) between RBP4 levels and risk of GDM.ResultsThe GDM cases had significantly higher levels of RBP4 in the first trimester than controls (medians: 18.0 μg/L vs 14.4 μg/L; P < 0.05). Plasma RBP4 concentrations in the first and second trimester were associated with fasting insulin, homeostasis model assessment for insulin resistance (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI) in the second trimester (all P < 0.001). With adjustment for diet, physical activity, and other risk factors for GDM, the risk of GDM increased with every 1-log μg/L increment of RBP4 levels, and the OR (95% CI) was 3.12 (1.08–9.04) for RBP4 in the first trimester and 3.38 (1.03–11.08) for RBP4 in the second trimester.ConclusionsPlasma RBP4 levels both in the first trimester and second trimester were dose-dependently associated with increased risk of GDM.
Highlights
Retinol-binding protein 4 (RBP4) was initially identified as a hormone secreted by the liver and acted as a vitamin A transport protein that facilitates the transfer of retinol from the liver to peripheral tissues [1]
No significant differences were found between cases and controls regarding maternal age, education, occupation, gestational weeks at enrollment, prepregnancy Body mass index (BMI), Gestational weight gain (GWG) before oral glucose tolerance test (OGTT), weekly physical activity time, daily intake of calories, systolic blood pressure (SBP), diastolic blood pressure (DBP), and those biochemical indicators at the first prenatal visit
Multivariable linear regression analysis showed that plasma retinol-binding protein 4 (RBP4) concentrations in the first and second trimester are the independent factor affecting fasting insulin, Homeostasis model assessment (HOMA)-IR and quantitative insulin sensitivity check index (QUICKI) in the second trimester, after adjustment for potential confounders, including biochemical indicators, daily intake of calories, and physical activity (Table 2)
Summary
Retinol-binding protein 4 (RBP4) was initially identified as a hormone secreted by the liver and acted as a vitamin A transport protein that facilitates the transfer of retinol from the liver to peripheral tissues [1]. Several previous studies assessed the association between RBP4 and GDM and yielded inconsistent results [7, 8]. A meta-analysis pooled results from 14 casecontrol studies reported that the serum RBP4 level was associated with the risk of GDM (pooled standardized mean difference = 0.816) [8]. This metaanalysis only includes one article in the “before 24 weeks” subgroup and no association between serum RBP4 level and GDM risk was found [9]. A prospective study revealed that early pregnancy RBP4 concentrations were associated with increased risk of GDM [7]. To assess the association between plasma retinol-binding protein 4 (RBP4) levels both in the first trimester and second trimester and risk of gestational diabetes mellitus (GDM)
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