Abstract
Waist-hip ratio (WHR) >0.85 reflects increased visceral adiposity (VA). Outside pregnancy, WHR better predicts insulin resistance (IR) than body mass index (BMI). Whether WHR predicts IR better than BMI in pregnancy remains unclear. Utilizing a large national cohort study, we investigated associations among first trimester (1st tri) WHR, 1st tri BMI & gestational IR, based on the 1hr glucose tolerance test (1hrGTT). We performed a secondary analysis of the prospective Nulliparous Pregnancy Outcomes Study, Monitoring Mothers-to-be (nuMoM2b). Subjects with 1st tri anthropometric measures & obstetrical outcomes were identified. Exclusion criteria were pregestational diabetes, autoimmune disease, steroid use or fetal anomalies. WHR (categorical exposure variable) was calculated from anthropometric measures; 1hrGTT (continuous outcome variable) was abstracted from medical records. We used linear and logistic regression to test associations between WHR, BMI & 1hrGTT. Regression models were adjusted for maternal age, 1st tri BMI, gestational weight gain & socio-economic status. Of 6455 subjects, 56% had normal WHR (NWHR< 0.8), 26% overweight WHR (OWHR 0.8-0.85), & 19% obese WHR (ObWHR >0.85; Table 1). In adjusted analyses, OWHR (β=3.62, 95% CI 1.97-5.28) & ObWHR (β=8.00, 95% CI 6.06- 9.95) associate significantly with increasing 1hrGTT (Table 2a). Correlations between WHR/1hrGTT appear stronger than BMI/1hrGTT in overweight (β=3.59, 95% CI 1.91-5.27) & obese (β=6.37, 95% CI 4.07-8.56) subjects. Additionally, subjects with ObWHR had higher odds of having 1hrGTT in the top quartile (OR 1.59, 95% CI 1.36-1.87), a stronger correlation than that between BMI & 1hrGTT in top quartile (OR 1.45, 95% CI 1.18-1.78; Table 2b). There is a positive “dose-response-like” association between WHR/1hrGTT & BMI/1hrGTT. Novel to our study, data from this multi-site cohort study suggest WHR may better associate with 1hrGTT than BMI, implying greater VA may underlie gestational IR. As GDM rates continue to rise, studies investigating mechanisms by which VA drives gestational IR are imperative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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