Gestational diabetes severity stratification during pregnancy: role of plasma oleic acid as a possible early marker

Normal pregnancy is characterized by changes in lipid metabolism with significant implications for the health of both mother and offspring. When these changes develop into maternal dyslipidemia, a significant association with adverse pregnancy outcomes has been observed, including the development of gestational diabetes (GD), modulation of the inflammatory response, and excessive fetal growth. In the present study, we performed a lipidomic assessment of patients at GD diagnosis (24-28 weeks of gestation) and 12 weeks after diagnosis. We found higher levels of esterified oleic acid in plasma at the time of GD diagnosis in women who subsequently required pharmacological therapy to control blood glucose levels compared to those who did not require additional treatment, suggesting that the measurement of plasma oleic acid might be an additional tool for the early identification of patients with a more severe form of gestational diabetes. Moreover, plasma oleic acid levels showed a positive correlation with fetal growth in the context of adequate glycemic control, supporting a metabolic dysregulation of other pathways whose identification could help clinicians to discriminate different cases within the spectrum of severity of the disease. Finally, the correlation between plasma oleic acid and circulating BAFF levels at the time of diagnosis and 12 weeks later adds a possible mechanism to support the pro-inflammatory and pro-diabetic state in the metabolic set of GD. Overall, these findings strongly support the role of plasma oleic acid as a possible early marker for GD severity stratification during pregnancy.