The Emerging Role of Biomarkers in the Diagnosis of Gestational Diabetes Mellitus

Abstract

Gestational diabetes mellitus (GDM) is a common complication of pregnancy; its rising incidence is a result of increased maternal obesity and older maternal age together with altered diagnostic criteria identifying a greater proportion of pregnant women with GDM. Its consequences are far-reaching, associated with poorer maternal and neonatal outcomes compared to non-GDM pregnancies, and GDM has implications for metabolic health in both mother and offspring. Objective markers to identify women at high risk for the development of GDM are useful to target therapy and potentially prevent its development. Established clinical risk factors for GDM include overweight/obesity, age, ethnicity, and family history of diabetes, though they lack specificity for its development. The addition of biomarkers to predictive models of GDM may improve the ability to identify women at risk of GDM prior to its development. These biomarkers reflect the pathophysiologic mechanisms of GDM involving insulin resistance, chronic inflammation, and altered placental function. In addition, the role of epigenetic changes in GDM pathogenesis highlights the complex interplay between genetic and environmental factors, potentially offering further refinement of the prediction of GDM risk. In this review, we will discuss the clinical challenges associated with the diagnosis of GDM and its current pathophysiologic basis, giving rise to potential biomarkers that may aid in its identification. While not yet validated for clinical use, we explore the possible clinical role of biomarkers in the future. We also explore novel diagnostic tools, including high throughput methodologies, that may have potential future application in the identification of women with GDM.

Glycated albumin in pregnancy: reference intervals establishment and its predictive value in adverse pregnancy outcomes

“…Adverse pregnancy outcomes of GDM affect both mothers and newborns in short and long terms. The women who were diagnosed with GDM have higher risk of type 2 diabetes and cardiovascular diseases after delivery [4]. In addition, GDM is closely associated with metabolism disorders, hypertensive disorders, preeclampsia (PE), large for gestational age (LGA, birth weight above the 90th percentile for gestational age), cesarean delivery and related birth injury in perinatal period [3,4].…”

Altered triglyceride and phospholipid metabolism predates the diagnosis of gestational diabetes in obese pregnancy

“…[18][19][20][21] Furthermore, there is mounting evidence that complications in labour consistent with GDM occur below some of these thresholds, [22][23][24] despite diagnosis and treatment. 25 This, and the complications associated with GDM and obesity, have motivated a focus on earlier diagnosis and prediction. However, most models employ a range of mainly non-molecular variables that have low sensitivity.…”

Early triglyceride and glucose index as a risk marker for gestational diabetes mellitus

“…Previous studies have explored the diagnostic value of first‐trimester maternal biomarkers of insulin resistance as a strategy to identify high‐risk populations and potential targets for intervention 5 . The hyperinsulinemic–euglycemic clamp is recognized as the gold standard to diagnose insulin resistance; however, it is expensive, time‐consuming, technically challenging, and has not been widely studied in pregnant patients.…”