title: Prediction of gestational diabetes in obese pregnant women from the UK Pregnancies Better Eating and Activity (UPBEAT) pilot trial.
abstract: OBJECTIVE
  To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester.
  
  
  METHODS
  A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity were studied. Blood samples were obtained at recruitment (15⁺⁰-17⁺⁶ weeks' gestation) and demographic, clinical history and anthropometric measures recorded. The biomarkers analysed were plasma lipids (HDL cholesterol, LDL cholesterol, triglycerides), high-sensitivity C-reactive protein, alanine transaminase, aspartate transaminase, ferritin, fructosamine, insulin, adiponectin, tissue plasminogen activator, interleukin-6, visfatin and leptin. Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model.
  
  
  RESULTS
  Of the 106 participants included in the analysis, 29 (27.4%) developed gestational diabetes. Participants with gestational diabetes were older (P = 0.002), more often of parity ≥ 2, had higher systolic (P = 0.02) and diastolic blood pressure (P = 0.02) and were more likely to be black (P = 0.009). Amongst the blood biomarkers measured, plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models (P = 0.002). The area under the receiver-operating curve for clinical factors alone (0.760) increased significantly (area under the curve 0.834, chi-square statistic (1) = 4.00, P = 0.046) with the addition of adiponectin.
  
  
  CONCLUSIONS
  A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes. Validation in a large prospective study is required to determine the usefulness of this algorithm in clinical practice.
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St. Thomas' Hospital, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Maitland
authors.forename: P T
authors.initials: PT
authors.lastname: Seed
authors.forename: A L
authors.initials: AL
authors.lastname: Briley
authors.forename: M
authors.initials: M
authors.lastname: Homsy
authors.forename: S
authors.initials: S
authors.lastname: Thomas
authors.forename: D
authors.initials: D
authors.lastname: Pasupathy
authors.forename: S C
authors.initials: SC
authors.lastname: Robson
authors.forename: S M
authors.initials: SM
authors.lastname: Nelson
authors.forename: N
authors.initials: N
authors.lastname: Sattar
authors.forename: L
authors.initials: L
authors.lastname: Poston
mesh_terms: D052242:Adiponectin / Q000097:blood; D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D003131:Combined Modality Therapy; D016640:Diabetes, Gestational / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004038:Diet, Reducing; D005260:Female; D006801:Humans; D009043:Motor Activity; D009765:Obesity / Q000097:blood / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy*; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000178:diet therapy / Q000503:physiopathology / Q000628:therapy*; D011262:Pregnancy Trimester, Second; D039401:Prenatal Nutritional Physiological Phenomena; D012680:Sensitivity and Specificity; D015854:Up-Regulation; D055815:Young Adult
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D015415:Biomarkers