Serum Test Allows Early Intervention
for Gestational Diabetes
New research indicates that pregnant women
who are destined to develop gestational diabetes
mellitus (GDM) in the third trimester have low
levels of sex hormone binding globulin (SHBG)
in the first trimester.
Therefore testing for this plasma protein could,
facilitate earlier interventions that may improve
outcomes.
Dr. Ravi Thadhani, from Massachusetts General
Hospital in Boston said that glucose tolerance
testing--the gold standard for diagnosing GDM--requires
fasting and is performed during the third trimester.
Unfortunately, "there are really no successful
interventions that alter the outcome of GDM once
it has been diagnosed."
If, however, "GDM could be predicted in the
first trimester, then there might be time for
interventions that would have a beneficial impact,"
he said.
"Sex hormone binding globulin has been shown
to be a good predictor of type II diabetes in
the non-pregnant state...so we decided to see
if it was also useful during pregnancy,"
Dr. Thadhani explained. Unlike glucose tolerance
testing, SHBG testing does not require fasting
and can be performed during the first trimester,
he added.
The current study involved 44 pregnant women who
developed GDM in the third trimester and 94 women
who did not. SHBG levels were measured in serum
samples that were collected from both groups during
the first trimester.
The authors' findings are published in the July
issue of the American Journal of Obstetrics and
Gynecology.
The average SHBG level in the GDM group was 187
nmol/L, significantly lower than the level in
the non-GDM group -- 233 nmol/L (p < 0.01)
-- the researchers report. Moreover, the SHBG
level remained an independent predictor of GDM
after adjusting for a variety of potential confounders,
such as body mass index, age, race, and blood
pressure.
For every 50-nmol/L rise in SHBG levels, the authors
found that the risk of GDM dropped by 31%.
This was a proof of principle study, so "we
don't have any figures for sensitivity or specificity,"
Dr. Thadhani noted. Larger studies are currently
in the works that will provide these figures,
he added.
Am J Obstet Gynecol 2003;189:171-176.
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