Can placenta be used to detect gestational diabetes?

The study was published in the journal Nature Medicine.

“The placenta plays a significant role in altering insulin physiology during pregnancy and may contribute to the development of gestational diabetes by secreting hormones. The researchers aimed to identify novel placental factors associated with gestational diabetes by studying all proteins expressed in placental tissues. Placental insulin-like growth factor 1 (IGFBP1) was identified as a potential regulator of glucose in human pregnancy.,” said Marie-France Hivert, Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute and lead author of the study.

The study team conducted genome-wide RNA sequencing on maternal-facing placental tissue samples, and measured identified proteins in blood collected in multiple pregnancy cohorts with diverse backgrounds.

The team identified 14 genes in the placenta associated with insulin resistance, with the strongest link found in gene IGFBP1. IGFBP1 protein levels increase during pregnancy and are significantly higher compared to non-pregnant individuals, suggesting the placenta as a major source. Low IGFBP1 levels in early pregnancy may predict gestational diabetes development later on. Additionally, IGFBP1 trajectories differ in those with a subtype of gestational diabetes prone to complications.

“Identifying a novel protein that characterizes a subtype of gestational diabetes is one additional step towards developing precision medicine for gestational diabetes. It’s possible that measuring IGFBP1 in the first trimester could help identify people at risk of developing gestational diabetes early in pregnancy, potentially offering a window for prevention. We hope to conduct future research to address whether this protein plays a causal role in gestational glycemic regulation,” added Dr. Hivert.

Reference: Hivert, MF., White, F., Allard, C. et al. Placental IGFBP1 levels during early pregnancy and the risk of insulin resistance and gestational diabetes. Nat Med (2024). https://doi.org/10.1038/s41591-024-02936-5