Low adiponectin concentrations before pregnancy are associated with a marked increase in risk for development of Gestational Diabetes Mellitus (GDM). The study aimed to examine whether circulating total and high–molecular weight (HMW) adiponectin concentrations, measured before pregnancy, are associated with subsequent risk of GDM. This was a nested case-control study among women who participated in the Kaiser Permanente Northern California Multiphasic Health Check-up exam (1984–1996) with a serum sample obtained and who had a subsequent pregnancy (1984–2009). Eligible women were free of recognized diabetes. Case subjects were the 256 women who developed GDM.

Results show that compared with the highest quartile of adiponectin, the risk of GDM increased with decreasing quartile (odds ratio [OR] 1.5 [95% CI 0.7–2.9], 3.7 [1.9–7.2], and 5.2 [2.6–10.1]; P trend <0.001) after adjustment for family history of diabetes, BMI, parity, race/ethnicity, cigarette smoking, and glucose and insulin concentrations. Similar estimates were observed for HMW (P trend <0.001).

If adiponectin is found to be low before pregnancy it can be a marker of decreased insulin sensitivity and altered adiponectin endocrine function and is associated with reduced glucose tolerance during pregnancy and may identify women at high risk for GDM to target for early intervention.

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