General Obstetrics and Gynecology: Obstetrics
Maternal plasma concentrations of IGF-1, IGFBP-1, and C-peptide in early pregnancy and subsequent risk of gestational diabetes mellitus

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Objective

Insulin-like growth factor-1 (IGF-1) and IGF binding protein-1 (IGFBP-1) may be important determinants of glucose homeostasis. We examined the association between circulating concentrations of IGF-1, IGFBP-1 in early pregnancy and development of gestational diabetes mellitus (GDM).

Study design

Maternal plasma (collected at 13 weeks) IGF-1, IGFBP-1, and C-peptide were measured using immunoassay. Relative risks (RR) and 95% CIs were calculated.

Results

The percentage of the cohort that developed GDM was 5.8% (n = 804). Free IGF-1 and IGFBP-1 were inversely associated with GDM risk, while C-peptide was positively associated with GDM risk (P for trend test < .05). Women with free IGF-1 ≥1.08 ng/mL experienced a 69% reduced risk of GDM (CI 0.12-0.75) compared with women having concentrations <0.80 ng/mL. There was a 57% reduced risk of GDM among women with IGFBP-1 ≥68.64 ng/mL (RR = 0.43, CI 0.18-1.05). Women with C-peptide ≥3.00 ng/mL experienced a 2.28-fold increased risk of GDM (CI 1.00-5.19) compared with women who had concentrations <1.45 ng/mL.

Conclusion

These associations may help to further elucidate the pathologic process of GDM.

Section snippets

Overall study design and population

The population for the present analysis was drawn from participants of the ongoing Omega study, which is designed to examine maternal dietary and lifestyle risk factors of preeclampsia and GDM. This study has been described in detail elsewhere.17 Women who initiated prenatal care before 16 weeks' gestation were eligible for the study. Participants were invited to provide blood samples and to participate in an interview that took place during the 13th week of gestation, on average. Maternal and

Results

The characteristics of women in the study cohort according to tertiles of plasma IGFBP-1 concentrations are summarized in Table I.

Maternal plasma free IGF-1 and IGFBP-1 concentrations were inversely correlated with prepregnancy BMI (r = −0.14 and r = −0.34, respectively, P < .01). Both determinants were also inversely correlated with maternal plasma leptin (r = −0.09, P = .01 and r = −0.17, P < .01, respectively), as well as C-reactive protein (CRP) (r = −0.23, P < .01 and r = −0.13, P < .01,

Comment

GDM, a heterogeneous complication of pregnancy, is characterized by carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Insulin resistance and β-cell dysfunction are thought to be major determinants of its development.18 Its pathophysiologic and epidemiologic characteristics in many ways resemble that of type 2 diabetes.13 An expanding body of evidence documents similarities between GDM and the metabolic syndrome.20 Our finding of an association

Acknowledgments

The authors are indebted to staff at the Center for Perinatal Studies, Swedish Medical Center.

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    Supported in part by an award from the National Institutes of Health (R01-HD/HL 32562).

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