SHBG

This nationwide case-control study investigated the associations of androgen excess and low sex hormone-binding globulin (SHBG) levels in early pregnancy with gestational diabetes mellitus (GDM) and its severity. Among 1045 women with GDM and 963 non-diabetic controls, women with GDM had lower SHBG levels (3.7% lower) and higher testosterone (3.1% higher) and free androgen index (FAI) (4.6% higher) compared to controls after adjusting for gestational age, pre-pregnancy BMI, and age. Low SHBG was associated with higher fasting glucose levels, early-onset GDM, and the need for insulin treatment for fasting hyperglycemia. In contrast, elevated testosterone and FAI were linked to higher post-prandial glucose concentrations. These findings suggest that low SHBG reflects insulin resistance, while androgen excess may impair post-prandial insulin secretion, contributing to GDM pathophysiology.