A robust biomarker panel could aid in the early detection of gestational diabetes.

UCLA researchers have taken the first step in determining what technique would be most effective in detecting gestational diabetes mellitus (GDM) earlier in pregnancy, potentially improving diagnosis and treatment for the most common pregnancy illness.

As a result of gestational diabetes, blood sugar levels rise, posing a risk to both the baby and the mother. In the mother, it can lead to high blood pressure, an increased chance of diabetes in the future, and a higher risk of c-section, as well as excessive birth weight, early delivery, and other complications in the infant. In the late second and third trimesters, traditional screening and lab tests are used to diagnose the problem. One element to lessening the impact of the illness is the capacity to predict it early.

Identifying GDM biomarkers early in pregnancy could lead to better monitoring and the development of safe and timely interventions and treatments that would minimise disease severity, therefore benefiting the mother's and offspring's long-term health.

The current study focused on extracellular vesicles (EVs), circulating "communicators" that contain and deliver microRNA genes (miRNAs) inside maternal blood. They are produced by the placenta and play a crucial role in pregnancy and pregnancy-related disorders such as gestational diabetes mellitus (GDM). Researchers took blood samples from 24 pregnant women during each trimester and at delivery to examine miRNA expression in EVs. They discovered a distinct expression of miRNA in EVs isolated from blood samples taken in the first trimester from women later diagnosed with GDM compared to women who had normal healthy pregnancies. The investigators saw changes in these miRNAs before clinical diagnosis, implying that they had a role in the disease's progression rather than being influenced by variables other than the disease or treatments like insulin, which can alter the miRNA content of circulating EVs.

Researchers also discovered upregulation of certain miRNA in first-trimester pregnancies that went on to be diagnosed with GDM, implying that miRNA cargo within circulating EVs may be communicating with other maternal organs and cell types, as well as interacting with signalling pathways involved in metabolism and inflammation, potentially influencing the maternal metabolic adaptations seen in women who develop GDM.

According to Devaskar, this is a promising first step toward developing a robust and accurate biomarker panel that performs far better than a single characteristic in predicting GDM during early pregnancy. This work adds to the growing body of evidence that GDM manifests significantly earlier than when it is normally clinically identified, at the midpoint of pregnancy, when effects are often irreversible. We are enthusiastic about this step toward the promise of more reliable and earlier diagnosis as providers of care for high-risk pregnant mothers and their kids so that we can act before the onset of severe problems for mother and baby that are sometimes a lifetime.

More research is needed to understand the mechanistic role of circulating EVs during pregnancy, their role in pregnancy complications, and the use of EV-associated miRNAs as non-invasive disease predictors in pregnancy, according to the authors. However, EV-associated miRNAs from the first trimester of pregnancy have the potential to act as an early gestation predictor of the subsequent development of GDM, before the emergence of characteristic clinical or biochemical features.