Dr. Mario Leesha Fernando,
BACKGROUND Gestational Diabetes Mellitus (GDM), described as glucose intolerance first recognized during pregnancy is usually diagnosed after screening at 24-28 weeks of gestation after the onset of the condition. Effective early identification of high-risk group and screening at an earlier time could improve pregnancy outcomes. Insulin resistance increases throughout the 2nd and 3rd trimester whereas the fat mass of the individual starts increasing from first trimester itself. The concentration of visfatin, an insulinomimetic and a novel adipocytokine is found to correlate with intra-abdominal adipose tissue and is found to be increased in cases of GDM. This change in visfatin levels can occur from the first trimester in response to adipose tissue remodelling and increased insulin resistance. We wanted to determine levels of visfatin in the first trimester of normal pregnancies and those who developed GDM later on during the pregnancy. The relationship between visfatin and parameters of glucose metabolism were also investigated. METHODS 84 primis between 11-13 weeks of gestation were randomly selected. BMI, concentration of plasma glucose, serum insulin, insulin resistance and serum visfatin were estimated. The participants of the study were followed up till 24-28 weeks of gestation and screened for GDM. Of the study population 17 women were diagnosed to have GDM and were treated as the case group. Means from both groups were analysed by Mann Whitney U test. The magnitude of correlations was determined by Pearson’s correlation coefficient. p Value of <0.05 was considered as statistically significant. RESULTS BMI, fasting plasma glucose (first trimester), fasting serum insulin, HOMA-IR and serum visfatin were all significantly higher in the GDM group than in the control group. There were no statistically significant correlations between visfatin and any of the indicators. CONCLUSIONS Pregnant women with higher visfatin levels at first trimester have higher levels of insulin resistance and are more likely to develop GDM independent of glycaemic status and adiposity. The increased levels of visfatin in the first trimester might be related to the development and progression of GDM
