Serum visfatin as a metabolic biomarker in obese patients with gestational diabetes mellitus.

BACKGROUND: Visfatin is an adipokine produced and secreted by the adipose tissue. It exerts an insulin-like effect by the insulin receptor-1 and has a hypoglycemic effect. We aimed to investigate how serum visfatin changes in women with gestational diabetes mellitus (GDM), and whether it is predictive of neonatal outcomes. METHODS: Visfatin levels were prospectively measured in peripheral blood serum by enzyme immunoassay in 210 pregnant women, 156 of which were diagnosed with GDM, 18 of which suffered from pregnancy-induced hypertension (PIH) and 36 healthy controls. RESULTS: Patients with obesity class II (median=2.562 ng/mL) and class III (median=6.2940 ng/mL) had higher serum visfatin than overweight patients (median=0.735 ng/mL); (Mann-Whitney U test, P=0.037 and P=0.023, respectively). In GDM patients with BMI above 30, serum visfatin was associated to glycosylated hemoglobin (Spearman correlation test, R=0.26, P=0.045). Women with BMI above 25 treated with insulin had lower serum visfatin levels than those treated with diet only (Mann-Whitney U test, P=0.045). No correlation was found between visfatin and parameters of lipid profile such as HDL, LDL, or triglycerides (Spearman correlation tests, R=-0.051, -0.1, 0.0019; P=0.54, 0.29, 0.98, respectively). We observed that visfatin was not associated with birth weight (Spearman correlation test, R=-0.014, P=0.86) or adverse neonatal outcome as measured by umbilical artery pH below 7.25 (Mann-Whitney U test, P=0.55) or Apgar score below 10 (Mann-Whitney U test, P=0.21). CONCLUSIONS: In GDM patients with higher BMI, serum visfatin was elevated, correlated positively with glycosylated hemoglobin, and decreased upon treatment with insulin therapy.

How mother's obesity may affect the pregnancy and offspring.

One of the main reasons for the epidemic of obesity, which has already influenced the economic condition of health system worldwide, is our modern lifestyle having an unbalanced calorie intake and insufficient physical activity. Maternal-fetal nourishment and metabolism are the mechanisms of fetal programming of obesity-adiposity and non-communicable diseases that have been most extensively investigated. A mother's obesity is related to adverse outcomes for both mother and baby. Maternal overnutrition is also associated with a higher risk of gestational diabetes, preterm birth, large-for-gestational-age babies, fetal defects, congenital anomalies, and perinatal death. Women with obesity should be encouraged to reduce their body mass index (BMI) prior to pregnancy, and to limit weight gain during pregnancy. Obstetric ultrasound imaging in pregnant women is negatively affected by abdominal adipose tissue, having an adverse influence on congenital anomaly detection rates and the estimation of fetal weight.