Date Published: February 2, 2018
Publisher: Public Library of Science
Author(s): Boya Li, Huixia Yang, Wanyi Zhang, Yundi Shi, Shengtang Qin, Yumei Wei, Yingdong He, Wenshuang Yang, Shiju Jiang, Hongyan Jin, Cheng Hu.
Fatty acid-binding protein 4 (FABP4) has been proposed to be a potential predictive factor of gestational hypertension or preeclampsia (GH/PE) because of its integrating metabolic and inflammatory responses. Women with gestational diabetes mellitus (GDM) are more likely to develop both GH/PE, than the normal population. The aim of our study was to examine the relationship between plasma FABP4 in the second trimester of pregnancy and the risk of GH/PE in women with GDM.
This was a nested case-control study conducted within a large on-going prospective cohort study conducted at Peking University First Hospital. A total of 1344 women, who were diagnosed with GDM, according to a 75 g oral glucose tolerance test, participated in the GDM One-Day Clinic at Peking University First Hospital from February 24, 2016 to February 9, 2017. Of the 748 GDM women who agreed to the blood sample collection, 637 were followed until their delivery. The cases included GDM patients who developed gestational hypertension or preeclampsia (GDM-GH/PE group, n = 41). Another 41 matched GDM women without major complications were selected as the control group (GDM group).
The incidence of GH/PE was 6.44% and 3.30% for preeclampsia. The level of the second trimester plasma FABP4 in the GDM-GH/PE group was significantly higher than the GDM group (17.53±11.35 vs. 12.79±6.04 ng/ml, P = 0.020). The AUC ROC for the second trimester plasma FABP4 predicted GH/PE in the GDM patients alone was 0.647 (95%CI 0.529–0.766). Multivariate analysis showed that the elevated second trimester FABP4 level was independently associated with GH/PE in the GDM patients (OR 1.136 [95% CI 1.003–1.286], P = 0.045).
Increased second trimester plasma FABP4 independently predicted GH/PE in GDM patients.
Gestational hypertension and preeclampsia (GH/PE) are characterized by insulin resistance and inflammation. Women with these diseases have an increased risk of developing metabolic syndrome and cardiovascular disease in the future.
Pregnant patients may develop the metabolic syndrome preceding or along the duration of pregnancy. Hypertensive disorders (including GH and PE) and gestational diabetes mellitus (GDM) are central attributes of the metabolic syndrome that may occur in pregnancy . They have some similar risk factors, such as obesity and insulin resistance, and have long-term influences on women’s health. GDM itself is one of the risk factors for pregnancy hypertension and preeclampsia . According to the literature reported over time and from different regions, the incidence of GH/PE in GDM women is 12% -17% [20, 21], and the incidence of PE in GDM women is 4%-8% [20, 22, 23]. The recent random sampling study of 15 hospitals in Beijing reported the incidence of GH/PE and PE at 6.2% and 3.7% in women with GDM, whereas only 3.8% and 2.4% in the unaffected population . Several studies have shown that serum FABP4 levels of GDM women were higher than the levels found in women with normal pregnancies [25–28]. Considering the potential relationship between FABP4 and preeclampsia, and its current evidence, we believe that FABP4 may be associated with different phenotypes of metabolic syndrome in pregnancy. To our knowledge, there have been no reports about whether the level of FABP4 in GDM women would affect their risk to develop GH/PE, subsequently.
In conclusion, our study suggested that increased second trimester plasma FABP4 independently predicted GH/PE in GDM patients.