Aims/hypothesis Concentrations of visfatin are increased in insulin-resistant conditions, but the relationship between visfatin and insulin and/or insulin resistance indices in pregnancy remains unclear. Insulin resistance in pregnancy is further accentuated in women with gestational diabetes mellitus (GDM). Thus we assessed serum levels of visfatin in pregnant women with varying degrees of glucose tolerance. Materials and methods Fasting visfatin levels were measured at 28 weeks of gestation in 51 women divided according to their response to a 50-g glucose challenge test (GCT) and a 75-g OGTT: control subjects (n=20) had normal responses to both a GCT and an OGTT; the intermediate group (IG; n=15) had a false-positive GCT, but a normal OGTT; the GDM group (n=16) had abnormal GCTs and OGTTs. Results There were no age or BMI differences between analysed groups. Across the subgroups there was a progressive increase in glucose and insulin at 120 min of the OGTT (p<0.01). This was accompanied by an increase in visfatin, from 76.8±14.1 ng/ml in the control subjects, to 84.0±14.7 ng/ml in the IG group and 93.1±12.3 ng/ml in the GDM group (p<0.01 for GDM vs control subjects). There was a positive correlation between visfatin and fasting insulin (r=0.38, p=0.007) and insulin at 120 min of the OGTT (r=0.39, p=0.006). Conclusions/interpretation An increase in fasting visfatin, the levels of which correlate with both fasting and postglucose-load insulin concentrations, accompanies worsening glucose tolerance in the third trimester of pregnancy. However, the significance of these findings, and in particular the role of visfatin in the regulation of insulin sensitivity during pregnancy, remains to be elucidated.

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