Gestational diabetes mellitus (GDM), a condition that affects approximately 10% of pregnancies worldwide, occurs when women without diabetes develop glucose intolerance during pregnancy. Typically detected in the second trimester, it can cause adverse outcomes including miscarriage, premature delivery, fetal malformation, and preeclampsia.
Now, a new study by Bar-Ilan University in Ramat Gan, Israel, has found that the mother’s gut microbiota can help doctors diagnose GDM in the first trimester of pregnancy—months earlier than typically detected. The study is one of the first to show reliable early prediction of GDM, a development that could drastically improve outcomes for mother and child.
A team of Israeli and international scientists collected fecal and serum samples from pregnant women during their first trimester and characterized their microbiota, metabolite, inflammation, and hormone profiles. The researchers also recorded information on the women’s diet, smoking, and other lifestyle habits, as well as medical data compiled from digital health records.
Using the results of these characterizations, combined with other collected data, scientists built a machine-learning model that can accurately predict which women would go on to develop gestational diabetes. There are marked differences in the first trimester gut microbiota of women who do and do not develop gestational diabetes, with women who develop gestational diabetes exhibiting higher inflammation and lower levels of beneficial metabolites. The study findings are not population specific, as results were replicated among diverse cohorts.
Writing in the journal Gut, the researchers noted that
we found broad and consistent evidence that GDM pathology begins as early as the first trimester in a large prospective cohort of pregnant women. Additionally, we successfully demonstrated that the precursors of GDM originate in the gut microbiota and that early-onset GDM has a bacterial signature at least partially responsible for the GDM phenotype.
Ultimately, the researchers say, the goal would be to stop GDM before it starts.
Recognition of women at risk of gestational diabetes at an early stage of pregnancy may allow specific recommendations for prevention of the disease—currently by lifestyle modification and in the future perhaps by specific pre, pro, and postbiotic supplementation says Prof. Omry Koren, lead author of the study.