Circulating levels of fibroblast growth factor 21 in gestational diabetes mellitus: a meta-analysis

Abstract

In recent times, the role of fibroblast growth factor 21 (FGF21) in patients with gestational diabetes mellitus (GDM) has been increasingly investigated. However, to our knowledge, no systematic analysis has been conducted yet to evaluate the relationship between FGF21 levels and GDM. Confirmed studies related to circulating FGF21 levels and GDM were searched from the databases of PubMed, ISI Web of Science, MEDLINE and EMBASE. Data were reported as standard mean difference (SMD) and associated 95% confidence intervals (CIs). Analysis were performed with Review Manager 5.2 and Stata version 11.0. A total of 392 cases and 435 controls in nine articles were included in this meta-analysis. The circulating FGF21 levels in pregnant women with GDM was higher than that in controls (random effects MD [95% CI] = 0.46, [0.07-0.86], p = 0.02). The result of multivariate meta-regression showed that sample size and point of sample collection contributed to heterogeneity (p = 0.033 and p = 0.047, respectively). Additionally, the results showed that there was no publication bias in this meta-analysis (Z = 1.36, p = 0.175; t = 1.24, p = 0.256, respectively). To conclude, this meta-analysis provides evidence that circulating FGF21 levels are higher in GDM subjects than controls, and it is important to clarify the relationship between circulating FGF21 levels and pregnant women with GDM in accurate prediction of GDM.

The relationship between serum adipokine fibroblast growth factor‐21 and gestational diabetes mellitus

“…However, previous studies have suggested that there are a variety of adipokines secretion disorders in GDM patients. In addition, GDM significantly increases the risk of long‐term adverse health problems for mothers and children, such as obesity, type 2 diabetes and cardiovascular disease 7 . Some studies have pointed out that GDM and type 2 diabetes have similar potential pathophysiology, and FGF21 has a similar relationship with GDM and type 2 diabetes 8 .…”

“…GDM occurs when pregnant women cannot produce enough insulin to compensate for reduced glucose processing. FGF‐21 is a hormone mainly expressed in the liver, but it is also expressed in other metabolically active tissues, such as the pancreas, skeletal muscle and adipose tissue 7 . FGF‐21 has emerged as an important regulator of energy metabolism with favorable effects on glucose and lipid homeostasis 17 .…”

“…There are many similarities between GDM and type 2 diabetes, and FGF21 might play a role in improving insulin resistance. Some studies 7 , 18 believe that FGF‐21 can regulate glucose uptake by adipocytes in an insulin‐independent manner, improve glucose tolerance and islet cell function, and enhance insulin sensitivity. FGF‐21 is associated with GDM and type 2 diabetes.…”

“…The pathogenesis of GDM is mainly considered to be due to the combination of the relative lack of insulin secretion and insulin resistance (IR) in pregnant women, but the specific mechanism is not clear. Recent studies have shown elevated levels of circulating FGF‐21 in patients with insulin resistance, including obesity and type 2 diabetes mellitus 7 . Elevated levels of FGF‐21 were also independent predictors of type 2 diabetes mellitus 8 .…”

Maternal overweight and obesity modify the association of serum fibroblast growth factor 21 levels with gestational diabetes mellitus: A nested case‐control study

“…15 However, this study lacked information on hyperglycemia status at baseline, potential confounders (e.g., lifestyles), and other metabolic traits (e.g., lipid profiles and homoeostasis model assessment of insulin resistance [HOMA-IR]), which may compromise the validity of the findings. In addition, while previous studies examined FGF21 levels in the early second trimester 15 or after the diagnosis of GDM using limited sample sizes (n = 24-180), 16,17 the prospective association between early pregnancy FGF21 levels and risk of GDM is still unclear. To improve the understanding of FGF21 levels in the development of GDM, we prospectively investigated the relationship between serum FGF21 levels in early pregnancy and subsequent risk of GDM among Chinese pregnant women as well as the correlations of FGF21 with metabolic profiles.…”