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Altered metabolic profiles seen in mothers who develop gestational diabetes

King’s researchers from the Faculty of Life Sciences and Medicine have found differences in the metabolic profiles of obese mothers who develop gestational diabetes compared to those who do not.

Antenatal obesity and associated gestational diabetes (GDM) are increasing worldwide.

Obesity is a well-known risk factor for developing diabetes during pregnancy (gestational diabetes mellitus or GDM), but only around 30% of obese pregnant women actually develop it. Sara White and her team from King’s have been undertaking research to explore the existence of underlying biochemical factors that could explain this. Insulin resistance is implicated in the development of gestational diabetes, but the team wanted to see if they could find biochemical evidence of this and other processes in the blood of obese women who develop GDM.

In the first study of its type, they used targeted Nuclear Magnetic Resonance (NMR) to compare the blood metabolic profile (i.e. the levels of fats, proteins and their components) in the blood of 646 pregnant and obese women at 17 weeks gestation and 27 weeks gestation. At 27 weeks gestation the women were also tested for gestational diabetes using a glucose tolerance test.

The results, were published in Diabetologia.

198 of the 646 pregnant women had developed GDM at 27 weeks. These women also had significant metabolic differences compared to the women who didn’t develop it. Most of these could be seen at 17 weeks, suggesting that underlying metabolic changes are present much earlier in pregnancy than the time of current diagnostic testing.

The findings strongly support testing for GDM in obese women earlier in gestation than currently practised, perhaps using novel metabolic tests such as the ones employed in this study along with traditional methods, to potentially improve treatment and outcomes.

Dr White says:

"It is fascinating to see biochemical differences between obese women with GDM and those without, encompassing both classic insulin resistance markers as well as other diverse pathways. In addition, the knowledge that such differences already exist early on in pregnancy further fuels the debate of the ideal timing for diagnosis of gestational diabetes, particularly in obese women."