This study aimed to determine whether third-trimester adipokines during gestational diabetes (GDM) are associated with higher metabolic risk.

A total of 221 women with GDM (according to IADPSG criteria) were enrolled between 2011/11 and 2013/6 into a prospective observational study (IMAGE), and categorized as having elevated fasting blood glucose (FBG) or impaired fasting glucose (IFG, n=36) if levels were≥92mg/dL during a 75-g oral glucose tolerance test (OGTT), impaired glucose tolerance (IGT, n=116) if FBG was<92mg/dL but with elevated 1-h or 2-h OGTT values, or impaired fasting and stimulated blood glucose (IFSG, n=69) if both FBG was≥92mg/dL and 1-h or 2-h OGTT values were elevated.

Pre-gestational body mass index (BMI) was higher in women with IFG or IFSG compared with IGT (P<0.001), as were leptin levels in women with IFG vs IGT [34.7 (10.5–119.7) vs 26.6 (3.56–79.4) ng/L; P=0.008]. HOMA2-IR scores were higher in women with IFG or IFSG vs IGT (1.87±1.2 or 1.72±0.9 vs 1.18±0.8, respectively; P<0.001). Also, those with IFSG vs those with IGT had significantly lower HOMA2-B scores (111.4±41.3 vs 127.1±61.6, respectively; P<0.05) and adiponectin levels [5.00 (1.11–11.3) vs 6.19 (2.11–17.7) μg/mL; P<0.001], and higher levels of IL-6 [1.14 (0.33–20.0) vs 0.90 (0.31–19.0); P=0.012] and TNF-α [0.99 (0.50–10.5) vs 0.84 (0.45–11.5) pg/mL; P=0.003]. After adjusting for age, parity, and pre-gestational and gestational BMI, the difference in adiponectin levels remained significant.

Diagnosing GDM by IADSPG criteria results in a wide range of heterogeneity. Our study has indicated that adipokine levels in addition to FBG may help to select women at high metabolic risk for appropriate monitoring and post-delivery interventions (ClinicalTrials.gov number NCP02133729).