Perinatal Changes in Serum Fibroblast Growth Factor 21 and Their Association With Postpartum Insulin Resistance in Women With Gestational Diabetes Mellitus

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AIM: This study aimed to clarify the clinical significance of perinatal changes in fibroblast growth factor 21 and their association with postpartum metabolic outcomes in women with gestational diabetes mellitus. METHODS: This single-center retrospective observational study used prospectively collected residual serum samples to investigate longitudinal changes in serum fibroblast growth factor 21 concentrations at approximately 26 (T1) and 36 (T2) weeks of gestation and within 7 days postpartum (T3) in 45 women with gestational diabetes mellitus and 30 controls. Associations between fibroblast growth factor 21 concentrations and postpartum metabolic outcomes were evaluated in the gestational diabetes mellitus group. RESULTS: Serum fibroblast growth factor 21 concentrations increased significantly from T1 to T2 and remained elevated at T3, irrespective of gestational diabetes mellitus status, as assessed using the Friedman test with post hoc comparisons. In women with gestational diabetes mellitus, fibroblast growth factor 21 showed predictive performance for postpartum insulin resistance, as assessed using the homeostasis model assessment of insulin resistance. Receiver operating characteristic analysis showed the highest area under the curve for predicting postpartum insulin resistance at T1 (area under the curve, 0.871; bootstrap 95% confidence interval, 0.732-0.973). Fibroblast growth factor 21 concentrations appeared to decline during the early postpartum period, as indicated by significantly lower T3/T1 ratios in samples from postpartum Days 5-7 compared with those from Days 1-4. CONCLUSIONS: These findings suggest that perinatal fibroblast growth factor 21 dynamics may reflect physiological changes in insulin sensitivity and that fibroblast growth factor 21 concentrations measured during pregnancy may serve as a complementary indicator for postpartum metabolic risk stratification in women with gestational diabetes mellitus. Further validation is needed before clinical application.

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