High plasma retinol binding protein-4 and low plasma adiponectin concentrations are associated with severity of glucose intolerance in women with previous gestational diabetes mellitus

Context: Women with previous gestational diabetes mellitus (pGDM) are at high risk of developing type 2 diabetes mellitus in the future. The role of adipokines in women with pGDM has not been established. Objective: We investigated whether circulating adipokine concentration is associated with abnormal glucose homeostasis in women with pGDM. Design, Setting, Patients, and Main Outcome Measures: We measured the plasma concentrations of retinol- binding protein-4 (RBP4), transthyretin (TTR), and adiponectin and metabolic parameters in four groups of women who exhibited normal glucose tolerance (NGT) during a previous pregnancy (NP, n = 17), NGT after GDM (GDM- NGT, n = 72), impaired glucose tolerance afterGDM (GDM-IGT, n = 60), and type 2 diabetes after GDM (GDM- DM, n = 8). Results: Plasma RBP4 concentration was significantly higher in women with GDM- DM, GDM-IGT, and GDM-NGT than in those with NP. RBP4 concentration correlated positively with TTR concentration; fasting plasma glucose, insulin, and triglyceride concentrations; blood pressure; abdominal fat area; and homeostasis model assessment of insulin resistance. Plasma TTR concentration was elevated in womenwithGDM- DMcomparedwithothergroups. In contrast, adiponectinconcentrationwaslowest in the GDM-DM group and correlated inversely with parameters of insulin resistance. Resistin concentration was higher only in the GDM- NGT and GDM-IGT groups, whereas leptin did not differ between groups. Plasma RBP4 and adiponectin concentrations were inversely correlated. Conclusions: The severity of glucose intolerance in women with pGDMis associated with high RBP4 and low adiponectin concentrations.