Concentrations Are Associated With aMarked Increase in Risk for Development of Gestational

OBJECTIVEdTo examine whether circulating total and high–molecular weight (HMW) adi-ponectin concentrations, measured before pregnancy, are associated with subsequent risk of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODSdThis 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 preg-nancy (1984–2009). Eligible womenwere free of recognized diabetes. Case subjects were the 256 women who developed GDM. Two control subjects were selected for each case and matched for year of blood draw, age at exam, age at pregnancy, and number of intervening pregnancies. RESULTSdCompared 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]; Ptrend,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 (Ptrend,0.001). The combined effects of having total adiponectin levels below themedian (,10.29 mg/mL) and being overweight or obese (BMI $25.0 kg/m2) were associated with