As the proportion of the world’s population who are overweight or obese has increased, the prevalence of gestational diabetes also has increased.  Gestational diabetes puts the mother and the infant at risk of clinically relevant metabolic complications.  Therefore, identification of viable early biomarkers in those individuals at risk of developing gestational diabetes is important if the prevalence of this disease is to be reduced and the effects mitigated.  A study conducted by Mokkala and colleagues evaluated the relationship between levels of several metabolites in early pregnancy and eventual gestational diabetes.  The results of that study are reported in the January 2020 issue of The Journal of Nutrition.

Subjects enrolled in the prospective study were overweight or obese (prepregnancy BMI > 25 or 30, respectively).  Fasting serum samples were analyzed for 228 metabolites (at ~14 weeks gestation), including biomarkers of lipid and glucose metabolism, amino acids, ketone bodies, and glycoprotein acetylation.  Gestational diabetes was determined using an oral glucose tolerance test conducted at approximately 26 weeks of gestation.

There were 78 lipid metabolites identified during early pregnancy as differing between those developing gestational diabetes and the healthy participants.  Many lipoprotein particles (VLDL and HDL) of various sizes were higher in women developing gestational diabtes.  Those with gestational diabetes also had higher concentrations of isoleucine and leucine, as well as glycoprotein acetylation, a marker for low-grade inflammation.  The most predictive biomarker of eventual gestational diabetes was a higher concentration of small-sized HDL particles.  These results led the authors to conclude that early detection of elevated levels of small HDL particles would be an effective biomarker of disease development, which could help target individuals for interventions to prevent the disease and the typical metabolic post-partum perturbations that follow gestational diabetes.

In a commentary, Fernandez supports the conclusions put forth by Mokkala and colleagues.  She cites the literature demonstrating that perturbations in lipoprotein profiles have been recognized as occurring with cardiovascular disease, inflammation, and diabetes.  Fernandez notes the potential benefit of easily detecting the changes in small HDL concentrations and recommends that serious consideration should be given to monitoring these metabolites during early pregnancy.

References Mokkala K, Vahlberg T, Pellonpera O, Houttu N, Koivuniemi E, Laitinen K. Distinct metabolic profile in early pregnancy of overweight and obese women developing gestational diabetes.  Journal of Nutrition, DOI:

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