March 29, 2017
2 min read

Serum zonulin level may predict gestational diabetes in pregnant women

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Women with higher levels of serum zonulin detected early in pregnancy were more likely to develop gestational diabetes by midpregnancy than women with lower levels, according to findings from a pilot study.

“The potential mechanism by which zonulin may contribute to the onset of gestational diabetes may originate from intestine,” Kirsi Laitinen, PhD, MSc, an adjunct professor with the Institute of Biomedicine at the University of Turku, Finland, told Endocrine Today. “Serum zonulin has recently been used as a marker of intestinal permeability, the increased concentrations reflecting an increased intestinal permeability. The increased serum zonulin concentration, in turn, may contribute to the onset of inflammation and again to development of insulin resistance.”

Kirsi Laitinen
Kirsi Laitinen

Laitinen, Kati Mokkala, MSc, of the Institute of Biomedicine at the University of Turku, and colleagues analyzed data from 88 pregnant women with overweight or obesity participating in an ongoing mother–infant dietary intervention trial aimed at preventing gestational diabetes (mean age, 30 years; mean prepregnancy BMI, 30.8 kg/m²; 57% with obesity). Researchers measured levels of serum zonulin in early pregnancy at the baseline study visit (mean, 12.8 weeks’ gestation); gestational diabetes was diagnosed based on a 2-hour oral glucose tolerance test performed at a mean of 26 weeks’ gestation. Mothers at higher risk for gestational diabetes underwent the OGTT at 14 weeks’ gestation with a repeat test if negative at midpregnancy. Researchers used logistic regression analysis to analyze the association between serum zonulin and gestational diabetes, adjusted for BMI, previous gestational diabetes (n = 5) and type 2 diabetes in the parents of the mother.

Within the cohort, 24 mothers were diagnosed with gestational diabetes, with eight diagnosed in early pregnancy and 16 diagnosed in midpregnancy. Mean serum zonulin concentration was 47 ng/mL.

Kati Mokkala
Kati Mokkala

Women who developed gestational diabetes had a higher serum zonulin concentration in early pregnancy vs. those who did not develop gestational diabetes (mean, 53.4 ng/mL vs. 45.2 ng/mL; P = .008). Zonulin concentration was associated with higher odds for developing gestational diabetes at midpregnancy (OR = 1.08; 95% CI, 1.02-1.15). Results persisted after women diagnosed in early pregnancy were included and after adjustment for type 2 diabetes or metabolic syndrome in the parents of the mother.

Using receiver operating characteristic curve analysis and the Youden index, researchers found that the optimal cutoff value for serum zonulin was 43.3 ng/mL–1 in predicting midpregnancy gestational diabetes, with a sensitivity of 88% (95% CI, 71-100) and a specificity of 47% (95% CI, 33-58).

“Currently, the diagnosis of gestational diabetes is based on OGTT, which is a laborious and expensive test,” Laitinen said. “The results of the present study, if confirmed in a larger setting, may offer opportunities for the development of a cheaper, speedier test for use in a clinical setting for predicting gestational diabetes or to find women at risk for gestational diabetes.”– by Regina Schaffer

For more information:

Kirsi Laitinen , PhD, MSc, can be reached at the Institute of Biomedicine at the University of Turku, 20014 Turun yliopisto, Finland; email:

Disclosure: The researchers report no relevant financial disclosures.