SFRP4 and gestational diabetes: High serum whole blood afamin and SFRP4 concentrations in the first trimester have been associated with the onset of gestational diabetes.47,48 Both afamin overexpression in transgenic mice49 and gestational diabetes in humans49,50,51 have been associated with a higher birth weight and/or increased risk of large for gestational age, which is in line with the findings of this study.