Abstract
BackgroundRecent studies have suggested that fetal sex influences maternal glucose and insulin metabolism during pregnancy. We examined whether fetal sex is associated with maternal insulin resistance and the β-cell function during mid-pregnancy.MethodsThis retrospective study included singleton pregnant women who underwent a 75-g oral glucose tolerance test (OGTT) at 24–34 weeks of gestation due to positive diabetic screening. In addition to plasma glucose (PG), we measured plasma insulin during the OGTT to obtain surrogate indices associated with insulin resistance (IR), including homeostasis assessment model (HOMA) -IR and insulin sensitivity index (IsOGTT), and β-cell function, including insulinogenic index (II), HOMA-β, and area under the curve of insulin response. We compared these indices between women carrying male fetuses to those carrying female fetuses.ResultsThe study population included 617 women (mean age, 32.4 ± 4.9 years) with a mean pre-pregnancy body mass index (BMI) of 22.6±4.5. They underwent the 75g-OGTT at 29.0 ± 2.5 weeks. Two hundred fifty-eight (42%) women were diagnosed with gestational diabetes (GDM). There was no significant difference in maternal age, pre-pregnancy BMI, gestational age at OGTT, PG at OGTT, or the prevalence of GDM between women with a male fetus (n=338) (male group) and those with a female fetus (n=279) (female group). Regarding the indices of IR, IR was significantly higher and insulin sensitivity was lower in the female group than in the male group (HOMA-IR: 7.0 [5-9.6] vs. 6.2 [4.6-8.8], p< 0.05; IsOGTT: 5.86 [4.29-7.83] vs. 6.29 [4.59-8.84], p< 0.01) (median [quartile range]). These differences remained significant after adjustment for maternal age, pre-pregnancy BMI, gestational age and fasting PG at OGTT, and the diagnosis of GDM. In contrast, the β-cell function did not differ between the two groups.ConclusionMaternal IR during mid-pregnancy was significantly higher in women carrying a female fetus than in those with a male fetus. The sex of the fetus may affect maternal insulin sensitivity during mid-pregnancy.
Highlights
Recent studies have suggested that fetal sex influences maternal glucose and insulin metabolism during pregnancy
We used two different diagnostic criteria to diagnose Gestational diabetes (GDM) during the study period: the Japan Society of Obstetrics and Gynecology (JSOG) criteria [6], which were used before June 2010, and the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria [7], which were used after July 2010
homeostasis assessment model of insulin resistance (IR) (HOMA-IR) was calculated as fasting plasma glucose (FPG) × fasting immunoreactive insulin (FIRI) / 405, and Insulin sensitivity index (IsOGTT) was calculated as 10,000 divided by the square root of (FPG × FIRI) ×
Summary
Recent studies have suggested that fetal sex influences maternal glucose and insulin metabolism during pregnancy. In maternal-fetal medicine, women carrying male fetuses have higher rates of fetal macrosomia, failure to progress during the first and second stages of labor, cord prolapse, nuchal cord, true umbilical cord knots, and cesarean section rate [1, 2]. These studies concluded that male sex is an independent risk factor for adverse pregnancy outcomes; the mechanisms by which fetal sex may contribute to these events are not clearly understood. The aim of our study was to examine whether fetal sex is associated with maternal insulin resistance (IR) and β-cell function during mid-pregnancy in Japanese pregnant women
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