PREGNANCY Longitudinal changes of adiponectin, carbohydrate and lipid metabolism in pregnant women at high risk for gestational diabetes GIANCARLO PARADISI 1 , FRANCESCA IANNIELLO 1 , CLAUDIA TOMEI 1 , MARINA BRACAGLIA 1 , BRIGIDA CARDUCCI 1 , MARIA ROSARIA GUALANO 2 , GIUSEPPE LA TORRE 3 , MARIA BANCI 4 , & ALESSANDRO CARUSO 1 1 Department of Obstetrics and Gynecology, Universita ` Cattolica del Sacro Cuore, Rome, Italy, 2 Epidemiology and Biostatistics Unit, HTA Unit, Institute of Hygiene, Universita ` Cattolica del Sacro Cuore, Rome, Italy, 3 Department of Experimental Medicine, Clinical Medicine and Public Health Unit, La Sapienza University of Rome, Rome, Italy, and 4 Department of Cardiology, Valmontone Hospital, Rome, Italy (Received 21 June 2009; revised 13 October 2009; accepted 23 November 2009) Abstract To evaluate, in pregnant women at high risk for gestational diabetes (GDM), the longitudinal changes of adiponectin, carbohydrate and lipid metabolism, and to assess their independent value as risk factors for the development of GDM. Fifty women at beginning of pregnancy were studied. Adiponectin, insulin sensitivity (homeostasis model assessment, HOMA) and lipid panel were measured at 1st, 2nd and 3rd trimesters of pregnancy. Twelve patients developed GDM. In both groups, GDM and normal glucose tolerance (NGT), adiponectin decreased from 1st to 2nd and 3rd trimesters by about 5 and 20% (GDM, p 5 0.05), and of about 17 and 25% in NGT ( p 5 0.05), respectively. Values observed in NGT were similar to those of GDM (F ¼ 9.401; p ¼ 0.238). The Cox regression model identified as the strongest independent risk factor for GDM HOMA over 1.24 (RR ¼ 14.12) at 1st trimester, fasting glycaemia over 87 mg/dl (RR ¼ 42.68) triglycerides over 158 mg/dl (RR ¼ 5.87) and body mass index (BMI) over 27 kg/m 2 (RR ¼ 4.38) at 2nd trimester. Adiponectin in high-risk women is characterised by a constant reduction throughout gestation, irrespective of the development of GDM. HOMA, fasting glycaemia, triglycerides and BMI, but not adiponectin are independent predictors of GDM. Keywords: Pregnancy, adiponectin, insulin resistance, adiposity, lipoproteins Introduction Adipose tissue has recently been found to secrete biologically active proteins including leptin, TNF-a, PAI-1, adipsin and resistin. Adiponectin, a 30-kD adipocytokine, is first described as the most abundant protein produced exclusively by adipocytes [1]. It appears to have a central regulatory role in many of the physiological pathways, controlling lipid and carbo- hydrate metabolism and to mediate various vascular processes [2]. In the general population, adiponectin plasma concentration is positively related to HDL- cholesterol levels and inversely related to blood pressure, LDL-cholesterol, triglycerides and body weight [3]. Paradoxically, it decreased in subjects with obesity and insulin-resistance states, including metabolic syndrome and diabetes, as well as hyper- tension and coronary heart disease [4–6]. Given its anti-inflammatory and anti-atherogenic properties on endothelial cells, low levels of adiponectin have been postulated to serve as a risk marker for diabetes and cardiovascular disease [7–9]. Recently, interest in adiponectin has also been focussed on pregnancy. In a series of studies, adiponectin plasma concentration has been shown to be lower in pregnant women with respect to non- pregnant women and, more interestingly, that preg- nant women who successively had gestational diabetes (GDM) presented a decreased adiponectin value than euglycaemic pregnancies [10–13]. On this basis, it has been speculated that reduced adiponectin at the beginning of pregnancy could be considered a risk Correspondence: Giancarlo Paradisi, Via Servilio IV 4, Rome 00178, Italy. Tel: þ39-6-30154852. Fax: þ39-6-35510031. E-mail: giancarlo.paradisi@tin.it Gynecological Endocrinology, July 2010; 26(7): 539–545 ISSN 0951-3590 print/ISSN 1473-0766 online ª 2010 Informa UK Ltd. DOI: 10.3109/09513591003632084