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Circulating B‐type natriuretic peptide in women with and without recent gestational diabetes: The impact of current glucose intolerance
Author(s) -
De Souza Leanne R.,
Ye Chang,
Hanley Anthony J.,
Connelly Philip W.,
Sermer Mathew,
Zinman Bernard,
Retnakaran Ravi
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13510
Subject(s) - prediabetes , medicine , gestational diabetes , endocrinology , impaired glucose tolerance , type 2 diabetes , diabetes mellitus , glucose tolerance test , natriuretic peptide , prohormone , context (archaeology) , pregnancy , gestation , insulin resistance , heart failure , hormone , biology , paleontology , genetics
Summary Context Circulating B‐type natriuretic peptide, as measured by the N‐terminal fragment of its prohormone ( NT ‐pro BNP ), is inversely associated with incident type 2 diabetes (T2 DM ) but positively related to future cardiovascular disease ( CVD ). Recognizing that gestational diabetes ( GDM ) identifies women at future risk for both T2 DM and CVD , we sought to determine whether gestational glucose tolerance relates to NT ‐pro BNP in the years after delivery. Design/Patients/Measurements Three hundred and forty women underwent a glucose challenge test ( GCT ) and an oral glucose tolerance test ( OGTT ) in pregnancy, yielding 4 gestational glucose tolerance groups: GDM (n = 105); gestational impaired glucose tolerance (n = 59); abnormal GCT with a normal OGTT (n = 98); and normal GCT with normal OGTT (n = 75). At 3‐year postpartum, they underwent cardiometabolic characterization (including measurement of estimated glomerular filtration rate ( eGFR ), adiponectin and NT ‐pro BNP ) and repeated the OGTT , revealing 69 women with glucose intolerance (prediabetes/diabetes). Results At 3‐year postpartum, serum NT ‐pro BNP did not differ between the 4 original gestational glucose tolerance groups ( P = .44), but instead progressively decreased across current glucose tolerance strata, from normal to prediabetes to diabetes ( P = .006). Indeed, on logistic regression analysis, NT ‐pro BNP emerged as a negative predictor of prediabetes/diabetes ( OR = 0.903, 95% CI 0.825‐0.988, P = .026). On multiple linear regression analyses of NT ‐pro BNP , the significant association with current glucose intolerance was ultimately attenuated in a fully adjusted model, revealing two independent determinants of NT ‐pro BNP : eGFR ( t = −2.71, P = .007) and adiponectin ( t = 2.44, P = .015). Conclusion Serum NT ‐pro BNP relates to current glucose intolerance, rather than preceding gestational dysglycaemia. Thus, the diabetic (rather than vascular) risk implications of NT ‐pro BNP predominate in young women.