Increased Serum Level of FGF21 in Gestational Diabetes Mellitus

Abstract

Objective. Gestational diabetes mellitus (GDM) is a common endocrine complication in pregnancy. There are few risk factors that clearly correlate with GDM. Fibroblast growth factor 21 (FGF21) is a metabolic hormone that can regulate glucose metabolism. It has been recognized that serum levels of FGF21 are significantly increased in diabetes and insulin resistance states. The objective of this study was to determine the serum FGF21 levels in women with GDM compared with non-GDM women and its correlation with insulin resistance. Methods. Thirty GDM patients and 60 healthy pregnant controls that matched for maternal and gestational age were selected. Women with previous history of GDM, hypertension, polycystic ovary syndrome, renal or liver failure and drug consumption with effects on glucose or insulin levels were excluded. FGF21 was determined and correlated with biochemical parameters of glucose metabolism and insulin resistance. Results. FGF21 concentration was significantly higher in GDM (264.5±196.2 ng/L) as compared with control groups (59.1±36.5ng/L). Correlation of FGF21 with insulin resistance was not significant. A cutoff 82.07 ng/L of FGF21 had sensitivity of 100% and specificity of 85% for prediction of GDM. Conclusion. FGF21 is increased in GDM and it is independent of insulin resistance. We suggest that FGF21 resistance could be directly involved in pathophysiology of GDM.

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

“…A meta-analysis of the nine articles was performed [12][13][14][15][16][17][18][19][20]. Data were all extracted as means ± SD, and significant heterogeneity existed in the studies (I 2 = 85%, p < 0.001, Fig.…”

FGF21 Serum Levels in the Early Second Trimester Are Positively Correlated With the Risk of Subsequent Gestational Diabetes Mellitus: A Propensity-Matched Nested Case-Control Study

“…Most of the studies found that the serum levels of FGF21 in GDM women were all elevated after 24 gestational weeks. Li et al and Bonakdaran et al found that GDM women had higher levels of FGF21 than NGT pregnant women at 24 to 28 gestational weeks (18,34). SǏMJÁK et al found that FGF21 in GDM women was higher than that in NGT pregnant women at 28 to 32 gestational weeks (35).…”

Predictive and diagnostic biomarkers for gestational diabetes and its associated metabolic and cardiovascular diseases

“…More interestingly, at the late 1st trimester, a reduction of plasma fetuin-A levels (and elevated hs-CRP) was also observed [121] (Table 3A). Another member of the FGF family, FGF-21, which induces the browning of white adipose tissue and acts as an upstream effector of adiponectin, was also expressed in placenta and increased in GDM women at the 24th week of gestation [148]. Also, afamin, a glycoprotein member of the albumin family expressed in liver and other peripheral tissues (i.e., placenta), may serve as an early (1st trimester) biomarker for pathological glucose and lipid metabolism during pregnancy [149].…”

“…The sensitivity could have been limited by the variability and quality of samples and detection method, and specificity could have decreased since most biomarkers point out common diabesogenic processes (i.e., insulin resistance, inflammation). In this regard, FGF-21 [148, 169], visfatin [127, 170], IL-6 [119, 171] and resistin [128, 129] displayed variable levels depending on pregnancy phase, and afamin, among others, could serve also as a valid biomarker for other complicated pregnancies, like those with preeclampsia [149]. In this line, GDM patients with cardiovascular risk could be classified by testing biomarkers with key roles on cardiovascular pathophysiology.…”