---
title: "Perinatal Serum FGF21 Changes and Postpartum Insulin Resistance in Gestational Diabetes"
id: "pubmed-42669966"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42669966"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42669966/"
doi: "10.1111/jog.70480"
published_at: "2026-09-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Perinatal Serum FGF21 Changes and Postpartum Insulin Resistance in Gestational Diabetes
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42669966
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42669966/)
- **DOI:** [10.1111/jog.70480](https://doi.org/10.1111%2Fjog.70480)
- **Published At:** 2026-09-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Aim: To determine the clinical significance of perinatal changes in serum **fibroblast growth factor 21 (FGF21)** and their association with postpartum metabolic outcomes in women with **gestational diabetes mellitus (GDM)**. - Study design: Single-center retrospective observational study using prospectively collected residual serum samples; longitudinal sampling in pregnancy and early postpartum. - Population and sampling: 45 women with GDM and 30 control women. Serum FGF21 measured at approximately 26 weeks (T1), 36 weeks (T2), and within 7 days postpartum (T3). - Main longitudinal finding: Serum **FGF21** concentrations rose significantly from T1 to T2 and remained elevated at T3 in both GDM and control groups (Friedman test with post hoc comparisons). - Postpartum insulin resistance association: In the GDM group, FGF21 measured during pregnancy predicted postpartum insulin resistance as assessed by HOMA-IR. The strongest predictive performance was at T1 (AUC 0.871; bootstrap 95% CI 0.732–0.973). - Early postpartum dynamics: FGF21 concentrations appeared to decline over the first week postpartum; T3/T1 ratios were significantly lower in samples from postpartum Days 5–7 versus Days 1–4. - Interpretation: Perinatal **FGF21** dynamics may reflect physiological shifts in **insulin sensitivity** and could serve as a complementary indicator for postpartum metabolic risk stratification in women with GDM. - Caution: The authors state that further validation is required before clinical application. Detailed protocol elements, full statistical parameters beyond those in the abstract, and longer-term outcomes were not reported in the source abstract. - Keywords emphasized: **FGF21**, **gestational diabetes**, **insulin resistance**, longitudinal survey, postpartum.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. * 2 Department of Obstetrics and Gynecology, Tone Chuo Hospital, Numata, Gunma, Japan. * 3 Department of Medical Education and Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. * PMID: **42669966** * DOI: [ 10.1111/jog.70480 ](https://doi.org/10.1111/jog.70480) Item in Clipboard Observational Study # Perinatal Changes in Serum Fibroblast Growth Factor 21 and Their Association With Postpartum Insulin Resistance in Women With Gestational Diabetes Mellitus Yosuke Suzuki et al. J Obstet Gynaecol Res. 2026 Sep. Show details Display options Display options Format Abstract PubMed PMID J Obstet Gynaecol Res Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Obstet+Gynaecol+Res%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Obstet+Gynaecol+Res%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42669966/) . 2026 Sep;52(9):e70480. doi: 10.1111/jog.70480. ### Authors [Yosuke Suzuki](https://pubmed.ncbi.nlm.nih.gov/?term=Suzuki+Y&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-2 "Department of Obstetrics and Gynecology, Tone Chuo Hospital, Numata, Gunma, Japan."), [Akihito Morita](https://pubmed.ncbi.nlm.nih.gov/?term=Morita+A&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan."), [Jun Okaniwa](https://pubmed.ncbi.nlm.nih.gov/?term=Okaniwa+J&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan."), [Ayuko Tanaka](https://pubmed.ncbi.nlm.nih.gov/?term=Tanaka+A&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-3 "Department of Medical Education and Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan."), [Yuko Hasegawa](https://pubmed.ncbi.nlm.nih.gov/?term=Hasegawa+Y&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan."), [Tatsuya Sato](https://pubmed.ncbi.nlm.nih.gov/?term=Sato+T&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan."), [Daisuke Higeta](https://pubmed.ncbi.nlm.nih.gov/?term=Higeta+D&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan."), [Akira Iwase](https://pubmed.ncbi.nlm.nih.gov/?term=Iwase+A&cauthor_id=42669966)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42669966/#short-view-affiliation-1 "Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.") ### Affiliations * 1 Department of Obstetrics and Gynecology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. * 2 Department of Obstetrics and Gynecology, Tone Chuo Hospital, Numata, Gunma, Japan. * 3 Department of Medical Education and Development, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan. * PMID: **42669966** * DOI: [ 10.1111/jog.70480 ](https://doi.org/10.1111/jog.70480) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Aim:** This study aimed to clarify the clinical significance of perinatal changes in fibroblast growth factor 21 and their association with postpartum metabolic outcomes in women with gestational diabetes mellitus. **Methods:** This single-center retrospective observational study used prospectively collected residual serum samples to investigate longitudinal changes in serum fibroblast growth factor 21 concentrations at approximately 26 (T1) and 36 (T2) weeks of gestation and within 7 days postpartum (T3) in 45 women with gestational diabetes mellitus and 30 controls. Associations between fibroblast growth factor 21 concentrations and postpartum metabolic outcomes were evaluated in the gestational diabetes mellitus group. **Results:** Serum fibroblast growth factor 21 concentrations increased significantly from T1 to T2 and remained elevated at T3, irrespective of gestational diabetes mellitus status, as assessed using the Friedman test with post hoc comparisons. In women with gestational diabetes mellitus, fibroblast growth factor 21 showed predictive performance for postpartum insulin resistance, as assessed using the homeostasis model assessment of insulin resistance. Receiver operating characteristic analysis showed the highest area under the curve for predicting postpartum insulin resistance at T1 (area under the curve, 0.871; bootstrap 95% confidence interval, 0.732-0.973). Fibroblast growth factor 21 concentrations appeared to decline during the early postpartum period, as indicated by significantly lower T3/T1 ratios in samples from postpartum Days 5-7 compared with those from Days 1-4. **Conclusions:** These findings suggest that perinatal fibroblast growth factor 21 dynamics may reflect physiological changes in insulin sensitivity and that fibroblast growth factor 21 concentrations measured during pregnancy may serve as a complementary indicator for postpartum metabolic risk stratification in women with gestational diabetes mellitus. Further validation is needed before clinical application. **Keywords:** fibroblast growth factor 21; gestational diabetes; insulin resistance; longitudinal survey; postpartum. © 2026 The Author(s). Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Serum fibroblast growth factor 21 levels in gestational diabetes mellitus in relation to insulin resistance and dyslipidemia. ](https://pubmed.ncbi.nlm.nih.gov/19699495/) Stein S, Stepan H, Kratzsch J, Verlohren M, Verlohren HJ, Drynda K, Lössner U, Blüher M, Stumvoll M, Fasshauer M.Stein S, et al.Metabolism. 2010 Jan;59(1):33-7. doi: 10.1016/j.metabol.2009.07.003. Epub 2009 Aug 21.Metabolism. 2010.PMID: 19699495 * [ Circulating 1,5-anhydroglucitol levels combined with pre-pregnancy BMI is a simple predictive marker of future glucose intolerance in women with gestational diabetes. ](https://pubmed.ncbi.nlm.nih.gov/41385135/) Quansah DY, Jiménez-Sánchez C, Maechler P, Puder JJ.Quansah DY, et al.J Endocrinol Invest. 2026 Apr;49(4):969-978. doi: 10.1007/s40618-025-02768-1. Epub 2025 Dec 12.J Endocrinol Invest. 2026.PMID: 41385135Free PMC article. * [ Perinatal and postpartum insulin secretion capacity in women with early-onset and late-onset gestational diabetes. ](https://pubmed.ncbi.nlm.nih.gov/41052823/) Katayama A, Hasegawa M, Morimoto E, Watanabe M, Matsushita Y, Takeda M, Kai K, Yoshida M, Tsukahara S, Okimoto N, Tada K, Kumazawa K, Hida K.Katayama A, et al.BMJ Open Diabetes Res Care. 2025 Oct 5;13(5):e005114. doi: 10.1136/bmjdrc-2025-005114.BMJ Open Diabetes Res Care. 2025.PMID: 41052823Free PMC article. * [ FGF21 and SHBG as Putative Hepatic Axes in Maternal Metabolic Adaptation: A Hypothetical Framework for Postpartum Insulin Sensitivity Restoration. ](https://pubmed.ncbi.nlm.nih.gov/42509792/) Purc-Bandurko K, Trojnar K, Masiarz A, Bandurko A, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B.Purc-Bandurko K, et al.Biomolecules. 2026 Jul 8;16(7):998. doi: 10.3390/biom16070998.Biomolecules. 2026.PMID: 42509792Free PMC article.Review. * [ Characteristics and pregnancy outcomes of subtypes of gestational diabetes mellitus based on HOMA-IR and BMI. ](https://pubmed.ncbi.nlm.nih.gov/39287682/) Jiang L, Li AQ.Jiang L, et al.Arch Gynecol Obstet. 2024 Nov;310(5):2355-2361. doi: 10.1007/s00404-024-07733-6. Epub 2024 Sep 17.Arch Gynecol Obstet. 2024.PMID: 39287682Review. [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42669966) ## References 1. 1. K. Falamarzi, M. Malekpour, M. F. Tafti, N. Azarpira, M. Behboodi, and M. Zarei, “The Role of FGF21 and Its Analogs on Liver Associated Diseases,” Frontiers in Medicine 9 (2022): 967375. 2. 1. X. Zhang, D. C. Yeung, M. Karpisek, et al., “Serum FGF21 Levels are Increased in Obesity and are Independently Associated With the Metabolic Syndrome in Humans,” Diabetes 57 (2008): 1246–1253. 3. 1. A. O. Chavez, M. Molina‐Carrion, M. A. Abdul‐Ghani, F. Folli, R. A. Defronzo, and D. Tripathy, “Circulating Fibroblast Growth Factor‐21 is Elevated in Impaired Glucose Tolerance and Type 2 Diabetes and Correlates With Muscle and Hepatic Insulin Resistance,” Diabetes Care 32 (2009): 1542–1546. 4. 1. B. E. Metzger, S. G. Gabbe, B. Persson, et al., “International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy,” Diabetes Care 33 (2010): 676–682. 5. 1. S. M. Li, W. F. Wang, L. H. Zhou, et al., “Fibroblast Growth Factor 21 Expressions in White Blood Cells and Sera of Patients With Gestational Diabetes Mellitus During Gestation and Postpartum,” Endocrine 48 (2015): 519–527. 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