602: Impaired expression of genes involved in glucose and lipid metabolism in non-obese GDM mouse model

Abstract

OBJECTIVE: Despite recommendations, compliance with postpartum screening in women diagnosed with gestational diabetes (GDM) is low. Identification of persistent impaired glucose tolerance provides the opportunity for early preventative interventions or treatment for Type 2 diabetes. Therefore, identification of a biomarker that can risk stratify those women at greatest risk may increase testing compliance and ultimately, long term women's health. We sought to evaluate whether maternal serum adiponectin and high-sensitivity C-reactive protein (hsCRP) levels at the time of GDM diagnosis are associated with persistent glucose intolerance in GDM women at 6-12 weeks postpartum. STUDY DESIGN: This is a secondary analysis of prospective randomized trial of GDM women enrolled in a behavior education program. Women with a GDM diagnosis ! 20 week were included. At the time of randomization (22-34 wks), serum adiponectin and hsCRP levels were drawn. After delivery, women underwent a 2hr 75g OGTT at 6-12 weeks postpartum. Persistent impaired glucose tolerance (P-IGT) was defined by: impaired fasting glucose, impaired glucose tolerance, or a diagnosis of Type 2 diabetes based on American Diabetes Association criteria. Regression models and receiver operator curves were used to evaluate the association between both midpregnancy adiponectin and hsCRP and P-IGT. RESULTS: Of 100 women in the trial, 63 completed postpartum glucose testing. 20 (31.7%) of the women had P-IGT. With the exception of gestational age at randomization, clinical characteristics including age, race, initial BMI, total weight gain, prior GDM history and fasting glucose during pregnancy were similar between women with normal glucose testing (N-GT) and those with P-IGT (p>0.05 for all). Median hsCRP levels were higher in women with P-IGT compared with N-GT women (5.1 vs. 3.8, p¼0.01). Overall, hsCRP was associated with threefold increased odds of P-IGT (OR: 3.38, 95% CI: 1.31-8.71, p¼0.01) and an AUC ¼0.72 (Figure). There was no difference in median adiponectin levels between groups (44.8 vs. 52.0, p¼0.57) or in odds of P-IGT (OR: 1.08, 95% CI: 0.39-2.98, p¼0.89) and AUC¼ 0.45. CONCLUSION: Midpregnancy hsCRP is a strong predictor of persistent impaired glucose tolerance diagnosed on the postpartum 2hr 75 gram OGTT in GDM women. Validation of this biomarker for clinical use is warranted.