Journal of Endocrinological Investigation

, Volume 28, Issue 3, pp 34–38 | Cite as

Inflammatory markers in women with a recent history of gestational diabetes mellitus

  • A. Di BenedettoEmail author
  • G. T. Russo
  • F. Corrado
  • E. Di Cesare
  • E. Alessi
  • G. Nicocia
  • R. D’Anna
  • D. Cucinotta
Original Article


Gestational diabetes mellitus (GDM) is a risk factor for both Type 2 diabetes (DM2) and insulin-resistance syndrome (IRS). C-reactive protein (CRP), fibrinogen and leukocyte count are increased in the IRS and predict DM2 and cardiovascular disease (CVD). The chemochine monocyte chemoattractant protein-1 (MCP-1/CCL2) is also elevated in DM2 and CVD. Recent evidence suggests a relation between chronic inflammation and GDM, but post-delivery information on inflammatory markers in these high-risk women is lacking. Serum levels of CRP, fibrinogen, MCP-1/CCL2, and leukocyte blood count have been assessed in 26 women with and 26 women without a recent history of GDM, matched for age, body mass index (BMI), post-partum duration and parity. DM2 was excluded in all the participants by an oral glucose tolerance test (OGTT). Women with previous GDM showed significantly higher CRP (p=0.007) and fibrinogen (p=0.02) serum concentrations, whereas MCP-1/CCL2 serum levels and leukocyte blood count were comparable in the two groups. Overall, CRP levels significantly correlated with BMI (r=0.40, p=0.03), waist-to-hip ratio (WHR) (r=0.44, p=0.001), fasting insulin (r=0.27, p=0.04), insulin-resistance assessed by means of the homeostatic model (HOMA) (r=0.28, p=0.04), and fibrinogen concentration (r=0.49, p=0.0001). At linear regression analysis, only WHR and fibrinogen were independently associated with CRP levels. In conclusion, the increase of inflammatory markers may be one of the first detectable disorders in healthy women at high risk of DM2 and IRS, like those with a GDM history.


CRP MCP-1/CCL2 fibrinogen gestational diabetes cardiovascular disease 


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  1. 1.
    The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2002, 25: S5–S20.CrossRefGoogle Scholar
  2. 2.
    Verma A, Boney CM, Tucker R, Vohr BR. Insulin resistance syndrome in women with prior history of gestational diabetes mellitus. J Endocrinol Metab 2002, 87: 3227–35.CrossRefGoogle Scholar
  3. 3.
    Meyers-Seifer CH, Vohr BR. Lipid levels in former gestational diabetic mothers. Diabetes Care 1996, 19: 1351–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care 2004, 27: 813–23.PubMedCrossRefGoogle Scholar
  5. 5.
    Pradhan AD, Manson JE, Rifai N, Buring JE, Ridker PM. Creactive protein, interleukin 6, and the risk of developing type 2 diabetes mellitus. JAMA 2001, 286: 327–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000, 342: 836–43.PubMedCrossRefGoogle Scholar
  7. 7.
    Schmidt MI, Duncan BB, Sharrett AR, et al. Markers of inflammation and prediction of diabetes mellitus in adults (Atherosclerosis Risk in Communities study): a cohort study. Lancet 1999, 353: 1649–52.PubMedCrossRefGoogle Scholar
  8. 8.
    de Maat MP, Pietersma A, Kofflard M, Sluiter W, Kluft C. Association of plasma fibrinogen levels with coronary artery disease, smoking and inflammatory markers. Atherosclerosis 1996, 121: 185–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin or leukocyte count with coronary heart disease: meta-analysis of prospective studies. JAMA 1998, 279: 1477–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Vozarova B, Weyer C, Lindsay RS, Pratley RE, Bogardus C, Tataranni PA. High white cell count is associated with a worsening of insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002, 51: 455–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Pasceri V, Cheng JS, Willerson JT, Yeh ET. Modulation of C-reactive protein mediated monocyte chemoattractant protein-1 induction in human endothelial cells by antiatherosclerosis drugs. Circulation 2001, 103: 2531–8.PubMedCrossRefGoogle Scholar
  12. 12.
    Nomura S, Shouzu A, Omoto S, Nishikawa M, Fukuhara S. Significance of chemokines and elevated platelets in patients with diabetes. Clin Exp Immunol 2000, 121: 437–43.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Piemonti L, Calori G, Mercalli A, et al. Fasting plasma leptin, tumor necrosis factor-α receptor 2, and monocyte chemoattracting protein 1 concentration in a population of glucose-tolerant and glucose-intolerant women. Diabetes Care 2003, 26: 2883–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Wolf M, Sauk J, Shah A, et al. Inflammation and glucose intolerance. A prospective study of gestational diabetes mellitus. Diabetes Care 2004, 27: 21–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Wolf M, Sandler L, Hsu K, Vossen-Smirnakis K, Ecker JL, Thadhani R. First trimester C-reactive protein and subsequent gestational diabetes. Diabetes Care 2003, 26: 819–24.PubMedCrossRefGoogle Scholar
  16. 16.
    Retnakaran R, Hanley AJ, Raif N, Connelly PW, Sermer M, Zinman B. C-reactive protein and gestational diabetes: the central role of maternal obesity. J Clin Endocrinol Metab 2003, 88: 3507–12.PubMedCrossRefGoogle Scholar
  17. 17.
    Carpenter MW, Coustan DR. Criteria for screening for gestational diabetes. Am J Obstet Gynecol 1982, 144: 768–73.PubMedGoogle Scholar
  18. 18.
    Corrado F, Caputo F, Facciola G, Mancuso A. Gestational glucose intolerance in multiple pregnancy. Diabetes Care 2003, 26: 1646.PubMedCrossRefGoogle Scholar
  19. 19.
    Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15: 539–53.PubMedCrossRefGoogle Scholar
  20. 20.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985, 28: 412–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Pickup JC, Crook MA. Is type II diabetes mellitus a disease of the innate immune system? Diabetologia 1998, 41:1241–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Festa A, D’Agostino R Jr, Howard G, Mykanen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000, 102: 42–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Frohlich M, Imhof A, Berg G, et al. Association between Creactive protein and features of the metabolic syndrome: a population-based study. Diabetes Care 2000, 23: 1835–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Landin K, Stigendal L, Eriksson E, et al. Abdominal obesity is associated with an impaired fibrinolytic activity and elevated plasminogen activator inhibitor-1. Metabolism 1990, 39: 1044–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Ghanim H, Garg R, Aljada A, et al. Suppression of nuclear factor-kappaB and stimulation of inhibitor kappaB by troglitazone: evidence for an anti-inflammatory effect and a potential antiatherosclerotic effect in the obese. J Clin Endocrinol Metab 2001, 86: 1306–12.PubMedGoogle Scholar
  26. 26.
    Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003, 107: 499–511.PubMedCrossRefGoogle Scholar
  27. 27.
    Yla-Herttuala S, Lipton BA, Rosenfeld ME, et al. Expression of monocyte chemoattractant protein 1 in macrophagesrich areas of human and rabbit atherosclerotic lesions. Proc Natl Acad Sci 1991, 88: 5252–6.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Fernandez-Real JM, Ricart W. Insulin resistance and inflammation in an evolutionary perspective: the contribution of cytokine genotype/phenotype to thriftiness. Diabetologia 1999, 42: 1367–74.PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2005

Authors and Affiliations

  • A. Di Benedetto
    • 1
    Email author
  • G. T. Russo
    • 1
  • F. Corrado
    • 2
  • E. Di Cesare
    • 1
  • E. Alessi
    • 1
  • G. Nicocia
    • 3
  • R. D’Anna
    • 2
  • D. Cucinotta
    • 1
  1. 1.Department of Internal MedicinePoliclinico Universitario “G. Martino”MessinaItaly
  2. 2.Department of Gynecological ScienceUniversity of MessinaMessinaItaly
  3. 3.Department of Experimental Pathology and MicrobiologyUniversity of MessinaMessinaItaly

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