Abstract
Obese women are more likely to have decreased insulin sensitivity and are at increased risk for many adverse pregnancy outcomes. An early lifestyle intervention (LI) may have the potential to reduce the impact of insulin resistance (IR) on perinatal outcomes. We report post hoc analysis of an open-label randomized control trial that includes IR women with body-mass index ≥25 randomly assigned to a LI with a customized low glycemic index diet or to standard care (SC) involving generic counseling about healthy diet and physical activity. Women were evaluated at 16, 20, 28, and 36 weeks of gestation, at which times perinatal outcomes were collected and analyzed. An oral-glucose-tolerance test (OGTT) showed that women in the LI group had lower plasma glucose levels at 120 min at 16–18 weeks of gestation, and at 60 and 120 min at 24–28 weeks. More importantly, these women had a lower rate of large-for-gestational-age (LGA) infants (p = 0.04). Interestingly, the caloric restriction and low-glycemic index diet did not increase the rate of small-for-gestational-age (SGA) babies in the LI group. A lifestyle intervention started early in pregnancy on overweight and obese women had the potential to restore adequate glucose tolerance and mitigate the detrimental role of IR on neonatal outcomes, especially on fetal growth.
Highlights
Obesity is among the risk factors for decreased insulin sensitivity or increased insulin resistance, defined as the decreased response of a nutrient to a given concentration of insulin at target tissue such as liver, muscle, or adipose tissue [1]
We aim to evaluate if those clinical improvements could benefit perinatal outcomes in the subgroup of women showing insulin resistance
Eighty-two women out of 217 (30.2%) showed insulin resistance (IR) according to a HOMA index >2.5 of 9–12 weeks of gestation and were included in the study
Summary
Obesity is among the risk factors for decreased insulin sensitivity or increased insulin resistance, defined as the decreased response of a nutrient to a given concentration of insulin at target tissue such as liver, muscle, or adipose tissue [1]. When this altered insulin status is prolonged, individuals are prone to developing metabolic syndrome and associated conditions such as diabetes, hypertension, hyperlipidemia, and cardiovascular disorders [2]. A pregnancy-related 60% decrease in insulin sensitivity puts overweight and obese women at greater risk for complications such as gestational diabetes mellitus (GDM), preeclampsia, and fetal growth abnormalities. Pregnancy was considered a metabolic-stress test for the lifelong risk of metabolic-syndrome development [1,4].
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