Biochemical markers of various subtypes of gestational diabetes

Background. The prevalence and severity of complications of gestational diabetes (GD) remain a significant problem worldwide. The desire to improve pregnancy outcomes; as well as an understanding of carbohydrate metabolism disorders; has led to studies demonstrating the presence of various pathogenetic subtypes of GD. Thus; studies have already demonstrated that pregnant women with GD and severe insulin resistance (IR) not only have more unfavorable prognoses; but also differ phenotypically and biochemically. Identification of biochemical markers of different GD subtypes has the potential to improve early diagnosis of a specific subtype and personalize treatment depending on the predominant pathogenetic factor.

Objective. Determineation of the biochemical markers for the diagnosis of various GD subtypes in pregnant women.

Methods. A single-center; observational; prospective; uncontrolled study included 130 pregnant women undergoing outpatient examination between March 2020 and March 2022. Based on the results of an oral glucose tolerance test with 75 g of glucose; 88 patients were diagnosed with GD: 43 were diagnosed with GD subtype with impaired β function-cells (GD I); 45 had the GD subtype with predominant IR (GD II); 42 patients formed the control group. Additionally; insulin was determined at three points to calculate the Matsuda index; fasting levels of total cholesterol (TC); triglycerides (TG); high and low density lipoproteins (LDL); apolipoprotein A (Apo-A); apolipoprotein B (Apo-B); adiponectin; leptin and omentin were examined

Results. Pregnant women from the GD II group had statistically significantly higher TG values (P=0.01 when compared with the GD I group; P<0.001 when compared with the control group); the total cholesterol and LDL levels were higher compared to those in patients from other groups; but these changes were not statistically significant. The (Apo-A) level was significantly higher in patients with GD (P<0.001 when comparing both GD groups with the control group) and did not differ when comparing different GD subtypes; in contrast to the Apo-B level; which was significantly higher in pregnant women from the group GD II compared with that in pregnant women from the other two groups (in both cases P=0.02). When studying adiponectin; leptin and omentin; statistically significant differences were detected only in the level of adiponectin (the lowest level in pregnant women from the GD II group compared with participants in other groups; P<0.001 when compared with the GD I group; P=0.004 – with the control group ). It was not possible to detect significant differences in omentin and leptin levels within the study.

Conclusion. High levels of Apo-B; TG; and low levels of adiponectin can be used as potential biomarkers in scientific and clinical practice to verify the pathogenetic subtype of GD with severe IR; most unfavorable factor regarding the prognosis according to previous studies.