Abstract
BackgroundThis study aimed to explore the relationship between insulin resistance (IR) and adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM), and to determine the risk factors for IR in women with GDM.MethodsThis study employed a retrospective survey of 710 women diagnosed with GDM. Serum lipids, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and serum protein were measured in the first trimester (6–12 weeks), and OGTT and fasting insulin tests were performed in the second trimester (24–28 weeks). These results were then used to evaluate IR by homeostasis model assessment (HOMA). When HOMA-IR ≥ 2.0, IR was diagnosed. The relationship between HOMA-IR and adverse pregnancy outcomes was analyzed by a logistic regression model, and multiple stepwise regression was used to analyze the risk factors of IR.ResultsIR significantly increasd the risk of the hypertensive disorders of pregnancy and large for gestational age (LGA) (OR = 5.31,95%CI:1.87,15.10; OR = 1.65,95%CI:1.10, 2.48, respectively) in women with GDM, but not for cesarean section, premature delivery, premature rupture of membranes, postpartum hemorrhage, macrosomia and SGA. Compared to normal groups, greater body mass index (BMI) before pregnancy category (overweight or obesity group) were associated with higher risk of IR in the second trimester, the OR (95% CI) were 4.09 (2.65, 6.30) and 6.52 (2.99, 14.20). And higher level of FPG (OR = 1.63, 95%CI: 1.11, 2.40), TG (OR = 1.32, 95%CI: 1.08, 1.63) and weight gain before diagnosis of GDM (OR = 1.08, 95%CI: 1.02, 1.15) were also associated with higher risk of IR in the second trimester in women with GDM, while age (OR = 0.94, 95%CI: 0.90, 0.98)was the weak protective factor for IR.ConclusionGDM with IR in the second trimester increased adverse pregnancy outcomes, especially the risk of hypertensive disorders of pregnancy and LGA. In addition, FPG, HbA1c, and TG in early pregnancy, pre-pregnant BMI and weight gain before diagnosis of GDM were all independent risk factors for IR.
Highlights
Gestational diabetes (GDM) is a common disease during pregnancy
This study aimed to determine whether insulin resistance (IR) in the second trimester is associated with certain specific adverse pregnancy outcomes, and to further explore the risk factors of IR in in the second trimester in Chinese gestational diabetes mellitus (GDM) women
IR is a state in which normal concentrations of insulin that the normal concentration of insulin can not elicit a response of target cells, and the negative feedback urges the body to secrete excess insulin
Summary
Gestational diabetes (GDM) is a common disease during pregnancy. GDM can bring about some short-term and long-term disorders to women and their babies, which has attracted increasing attention from the entire society. Previous literature show that excessive gestational weight gain (GWG)[4], overweight or obesity [5], personal history of GDM [6], family history of diabetes [6], westernized diet [7], advanced maternal age [8], intrauterine nutrition status [9], are high risk factors for IR. This study aimed to explore the relationship between insulin resistance (IR) and adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM), and to determine the risk factors for IR in women with GDM
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