Currently submitted to: JMIR Research Protocols
Date Submitted: Jan 23, 2026
Open Peer Review Period: Jan 26, 2026 - Mar 23, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Identifying metabolic pathways that drive gestational diabetes in pregnancy: Protocol for a prospective observational study
ABSTRACT
Background:
Gestational Diabetes is a disorder characterised by hyperglycaemia that is first recognised during pregnancy due to a mismatch between the placental hormones produced, causing insulin resistance. Few studies have systematically examined the metabolic pathways responsible for gestational diabetes from diagnosis to the postnatal period, including the metabolic changes in the placenta through metabolomics studies.
Objective:
This study aimed to evaluate the metabolites identified through metabolomics, as well as their associated pathways, responsible for hyperglycaemia in the gestational period across pregnancy and postpartum, compared to those without diabetes during pregnancy. Serum samples are taken at 24-28 weeks of gestation, followed by placental samples, cord blood, and postnatal serum samples between 4 and 12 weeks.
Methods:
Anthropometric data is collected at the first visit. Samples are collected at three points: serum or plasma samples at the time of diagnosis of gestational diabetes or the first visit after diagnosis, placental samples and cord blood samples during delivery, and during the postpartum period. Macroscopic and microscopic features of the placenta are noted. The metabolic pathways between GDM and non-GDM mothers across pregnancy, starting from the diagnosis of gestational diabetes, and the changes in pathways in the placenta, cord blood, and postnatal blood will be compared.
Results:
The study was funded by an institutionally funded research grant in January 2025. Recruitment for the study began in June 2025 and is expected to be completed by June 2026. We plan to recruit 40 patients with GDM and age- and BMI-matched normoglycaemic controls.
Conclusions:
The findings from this study will provide insight into the various metabolites or biomarkers and their metabolic pathways involved in the pathogenesis of gestational diabetes across the life course of mothers, compared with those of normoglycemic mothers, and offer potential insight into the role of the placenta in gestational diabetes.
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