Cord serum dipeptidyl-peptidase 4 activity in gestational diabetes

Background Tissue‐specific dipeptidyl‐peptidase 4 (DPP4) dysregulation has been described in adults with diabetes mellitus. The DPP4 ‐incretin system has not been studied in foetal life. In this study, DPP4 activity and glucagon‐like peptide‐1 (GLP‐1) levels were assessed in cord blood of neonates born to women with gestational diabetes mellitus (GDM) and nondiabetic controls. Material and methods This study has been conducted in two Hungarian and one Austrian centres. Patients: A total of 568 pregnant women were enrolled in the study after their OGTT between the 24th and 28th gestational week. Cord blood samplings with DPP4 activity and GLP‐1 level measurements were possible in 270 (DPP4: 159 control, 111 GDM) and 112 (GLP‐1: 72 control, 40 GDM) cases. OGTT (24–28th gestational week) and cord blood sampling at delivery were performed. Cord serum DPP4 activity was determined in a continuous monitoring microplate‐based kinetic assay, and cord plasma GLP‐1 was measured using a fluorescence ELISA method. Results Cord serum DPP4 activity was lower in GDM [mean (95% CI): 28·07 U/L (26·32–29·82 U/L)] than in controls [31·61 U/L (29·93–33·29 U/L), MWU P = 0·0015]. Cord plasma active GLP‐1 levels were close to the lower detection limit and were not altered in GDM (control: mean = 3·43 pM, 95% CI: 3·04–3·82 pM, GDM: mean = 3·61 pM, 95% CI: 2·96–4·28 pM – MWU test P = 0·6). Conclusions Decreased cord serum DPP4 activity in gestational diabetes mellitus might be the result of an adaptive foetal response or an early dysregulation in the entero‐insular axis with consequences beyond the incretin system. Cord plasma GLP‐1 levels may reflect the missing oral intake with a limited glucose sensing of L cells via the circulation in foetal life.