Serum fibroblast growth factor 21: Lack of association with gestational diabetes and pregnancy outcomes

BACKGROUND The prevalence of gestational diabetes mellitus (GDM) has been increasing worldwide and is associated with multiple adverse pregnancy outcomes. Despite standard screening, some cases remain undiagnosed. Fibroblast growth factor 21 (FGF21) plays a role in modulating glucose metabolism. There is an ongoing controversy regarding the relevance of FGF21 to GDM. AIM To evaluate the association between early second trimester serum FGF21 levels and gestational diabetes, and its predictive potential for outcomes. METHODS This cross-sectional observational study was conducted at a tertiary medical center, Chiang Mai University, Thailand. It included 28 pregnant women diagnosed with GDM and 81 pregnant women with normal glucose status. Blood samples were collected according to the study schedule, and pregnancy outcomes were recorded meticulously. Descriptive analysis was employed to evaluate the data. RESULTS Most participants in our study had no risk factors for GDM (body mass index < 24 kg/m2, no first-degree relatives with diabetes, no history of GDM), normal baseline glucose status (fasting glucose < 110 mg/dL), and no insulin resistance (homeostatic model assessment of insulin resistance < 2). There was a trend of increased FGF21 levels in the insulin-treated GDM group compared with dietary-treated GDM and non-GDM (73.58 pg/mL vs 62.94 pg/mL vs 63.59 pg/mL, respectively, P = 0.73). However, no significant association was found between FGF21 concentrations and pregnancy outcomes based on quintiles of FGF21 levels. CONCLUSION FGF21 was not associated with GDM or pregnancy outcomes; however, due to the small sample size, larger clinical trials with a diverse population are suggested to confirm these results.