IGF-I to IGFBP-3 ratio

This prospective case-control study examined the role of insulin-like growth factor (IGF) axis biomarkers in early-to-midpregnancy in predicting the risk of gestational diabetes mellitus (GDM). A total of 107 women with GDM and 214 matched controls were analyzed, with plasma samples collected at four gestational intervals: 10–14 weeks, 15–26 weeks, 23–31 weeks, and 33–39 weeks. The study found that IGF-I, IGF binding protein 3 (IGFBP-3), and the molar ratio of IGF-I to IGFBP-3 increased throughout pregnancy, while IGFBP-2 levels decreased. Notably, higher IGF-I and IGF-I/IGFBP-3 levels at 10–14 weeks were associated with increased GDM risk, with adjusted odds ratios (ORQ4-Q1) of 2.93 (95% CI 1.18–7.30) for IGF-I and 3.31 (95% CI 1.10–9.98) for IGF-I/IGFBP-3. Conversely, higher IGFBP-2 levels were associated with a markedly reduced risk of GDM (ORQ4-Q1 0.04 [95% CI 0.01–0.06]). Similar associations were observed at 15–26 weeks of gestation. These findings underscore the potential role of the IGF axis, particularly IGFBP-2, in the early pathogenesis of GDM, with predictive associations detectable up to 18 weeks before typical GDM screening. This highlights the potential of IGF axis biomarkers as early predictors for GDM risk.