title: Plasma adiponectin, insulin sensitivity, and subclinical inflammation in women with prior gestational diabetes mellitus.
abstract: OBJECTIVE
  Women with prior gestational diabetes mellitus (pGDM) are at increased risk of developing type 2 diabetes and associated vasculopathy. Because increased fat mass and inflammatory processes are angiopathic risk factors, the relationship between insulin sensitivity, parameters of subclinical inflammation, and plasma concentrations of adipocytokines was investigated in pGDM both at 3 months and 12 months after delivery.
  
  
  METHODS
  Insulin sensitivity (through a frequently sampled intravenous glucose tolerance test) and plasma concentrations of ultrasensitive C-reactive protein (CRP), adiponectin, plasminogen activator inhibitor (PAI)-1, tumor necrosis factor-alpha, leptin, and interleukin-6 were measured in 89 pGDM (BMI 26.9 +/- 0.5 kg/m(2), age 32 +/- 0.5 years) and in 19 women with normal glucose tolerance during pregnancy (NGT) (23.7 +/- 0.9 kg/m(2), 31 +/- 1.3 years).
  
  
  RESULTS
  pGDM showed lower (P < 0.0001) plasma adiponectin (6.7 +/- 0.2 microg/ml) than NGT (9.8 +/- 0.6 microg/ml) and a decreased (P < 0.003) insulin sensitivity index (S(i)) and disposition index (P < 0.03), but increased plasma leptin (P < 0.003), PAI-1 (P < 0.002), and CRP (P < 0.03). After adjustment for body fat mass, plasma adiponectin remained lower in pGDM (P < 0.004) and correlated positively with S(i) (P < 0.003) and HDL cholesterol (P < 0.0001) but negatively with plasma glucose (2-h oral glucose tolerance test [OGTT]) (P < 0.0001), leptin (P < 0.01), CRP (P < 0.007), and PAI-1 (P < 0.0001). On regression analysis, only HDL cholesterol, postload (2-h OGTT) plasma glucose, and S(i) remained significant predictors of plasma adiponectin, explaining 42% of its variability. Of note, adiponectin further decreased (P < 0.05) only in insulin-resistant pGDM despite unchanged body fat content and distribution after a 1-year follow-up.
  
  
  CONCLUSIONS
  Lower plasma adiponectin concentrations characterize women with previous GDM independently of the prevailing insulin sensitivity or the degree of obesity and are associated with subclinical inflammation and atherogenic parameters.
authors.affiliation: Department of Medicine III, Vienna University Hospital, Vienna, Austria.
authors.forename: Christine
authors.initials: C
authors.lastname: Winzer
authors.forename: Oswald
authors.initials: O
authors.lastname: Wagner
authors.forename: Andreas
authors.initials: A
authors.lastname: Festa
authors.forename: Barbara
authors.initials: B
authors.lastname: Schneider
authors.forename: Michael
authors.initials: M
authors.lastname: Roden
authors.forename: Dagmar
authors.initials: D
authors.lastname: Bancher-Todesca
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pacini
authors.forename: Tohru
authors.initials: T
authors.lastname: Funahashi
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kautzky-Willer
mesh_terms: D052242:Adiponectin; D002097:C-Reactive Protein / Q000032:analysis; D016640:Diabetes, Gestational / Q000097:blood* / Q000503:physiopathology; D005260:Female; D006801:Humans; D006946:Hyperinsulinism; D007249:Inflammation / Q000453:epidemiology*; D007328:Insulin / Q000494:pharmacology; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism*; D009765:Obesity / Q000097:blood; D017395:Plasminogen Activator Inhibitor 1 / Q000032:analysis; D011247:Pregnancy
chemical_list: D052242:Adiponectin; D007328:Insulin; D036341:Intercellular Signaling Peptides and Proteins; D017395:Plasminogen Activator Inhibitor 1; D002097:C-Reactive Protein