Pregnancy Resistance Research Articles

EP08.03: Perinatal outcomes and maternal characteristics in pregnancies with abnormal 50G oral glucose challenge test and normal 100G oral glucose tolerance test results

To investigate the maternal characteristics and obstetric outcomes in pregnancies with abnormal 50 g oral glucose challenge test (50gOGCT) and normal 100 g oral glucose tolerance test (100gOGTT) results. Antenatal follow-up and delivery records were retrospectively evaluated in 379 pregnancies with normal 50gOGCT results (group1), 107 pregnancies with abnormal 50gOGCT but normal 100gOGTT (group 2) and 75 pregnancies diagnosed and treated as gestational diabetes mellitus (GDM) (group 3), excluding the cases with pre-gestational diabetes mellitus and multiple pregnancies. Maternal age was significantly higher in group 2 compared to group 1 and higher in group 3 compared to group 2 (p < 0.05). Gestational age at birth was significantly lower in groups 2 and 3 compared to group 1 (p < 0.05). Idiopathic polihidramnios was present in 0.3%, 2.8% and 2.7% of the cases in group 1, 2 and 3 respectively (p < 0.05). Fetal anomaly was observed in 2.4%, 4.7% and 5.3% of the cases (p < 0.05) and perinatal mortality was observed in 0.5%, 1.9% and 1.3% of the cases (p > 0.05), respectively. Insulin resistance in pregnancy may be more frequently encountered as maternal age increases. Poor outcome cannot be fully eliminated in pregnancies with GDM despite treatment. In cases with abnormal 50gOGCT but normal 100gOGTT results, poor outcome may be observed more frequently than in those with normal 50gOGCT results, perhaps due to the presence of a moderate degree of insulin resistance. Further studies must be performed to clarify these facts.

Insulin resistance in pregnancy complicated by type 1 diabetes mellitus. Do we know enough?

Insulin resistance (IR) is defined clinically as the inability of a known quantity of exogenous or endogenous insulin to increase glucose uptake and utilization. In recent years the increasing role of IR in the pathogenesis of type 1 diabetes mellitus (T1DM) related complications has been taken into account. The aim of this article is to discuss the possible role of IR in pregnancy complicated by T1DM. At the moment, there is no doubt that IR is not only frequently observed in T1DM patients, but also is a separate risk factor of several complications in nonpregnant patients. The role of IR in pregnancy complicated by T1DM has not been widely studied yet. However, data from the studies on different populations showed that IR may predispose to such conditions as miscarriage, preeclampsia and macrosomia. Interestingly all of these are more frequently diagnosed in women with T1DM in comparison to healthy subjects. The literature on the role of IR in human pregnancy is relatively rich. However despite its significance in pathophysiology of T1DM and its complications in general population, there is a lack of understanding of how it affects maternal and fetal health in pregnancy complicated by this disease. Nonetheless, based on the available literature, IR may be proposed as an additional factor modifying pregnancy outcome in woman with T1DM. Therefore, measures that might reduce IR such as good glycemic control and control of weight gain should be recommended for every woman with T1DM, optimally when planning but also throughout the pregnancy

Female fetus is associated with greater maternal insulin resistance in pregnancy.

To explore the hypothesis that female fetus is associated with greater maternal insulin resistance during pregnancy. In a singleton pregnancy cohort study (n = 299), we compared maternal insulin resistance according to fetal sex, based on plasma biomarkers from a 50-g 1-h oral glucose tolerance test at 24-28 weeks gestation. The primary outcome was plasma glucose-to-insulin ratio. Other outcomes included plasma proinsulin-to-insulin ratio, and insulin, proinsulin, leptin, adiponectin and insulin-like growth factor I and II concentrations. After adjusting for maternal race, age, parity, education, pre-pregnancy BMI, smoking and alcohol use, history of gestational diabetes, and gestational age at blood sampling, plasma insulin concentrations were significantly higher (mean ± sd: 66.4 ± 50.5 vs. 51.0 ± 46.1 mU/l; adjusted P = 0.001), and glucose-to-insulin ratios significantly lower (2.60 ± 2.03 vs. 3.77 ± 4.98 mg/dl/mU/l; adjusted P = 0.002) in women bearing a female vs those bearing a male fetus, despite similar glucose levels (116.4 ± 27.2 vs. 117.0 ± 31.9 mg/dl; adjusted P = 0.92).There were no significant differences in proinsulin-to-insulin ratios, or leptin, adiponectin, insulin-like growth factor I and insulin-like growth factor II concentrations by fetal sex. Female fetus may be associated with greater maternal insulin resistance during pregnancy.

20 years of leptin: leptin and reproduction: past milestones, present undertakings, and future endeavors.

The association between leptin and reproduction originated with the leptin-mediated correction of sterility in ob/ob mice and initiation of reproductive function in normal female mice. The uncovering of a central leptin pathway regulating food intake prompted the dissection of neuroendocrine mechanisms involving leptin in the metabolic control of reproduction. The absence of leptin receptors on GnRH neurons incited a search for intermediary neurons situated between leptin-responsive and GnRH neurons. This review addresses the most significant findings that have furthered our understanding of recent progress in this new field. The role of leptin in puberty was impacted by the discovery of neurons that co-express kisspeptin, neurokinin B, and dynorphin and these could act as leptin intermediates. Furthermore, the identification of first-order leptin-responsive neurons in the premammilary ventral nucleus and other brain regions opens new avenues to explore their relationship to GnRH neurons. Central to these advances is the unveiling that agouti-related protein/neuropeptide Y neurons project onto GnRH and kisspeptin neurons, allowing for a crosstalk between food intake and reproduction. Finally, while puberty is a state of leptin sensitivity, mid-gestation represents a state of leptin resistance aimed at building energy stores to sustain pregnancy and lactation. The mechanisms underlying leptin resistance in pregnancy have lagged; however, the establishment of this natural state is significant. Reproduction and energy balance are tightly controlled and backed up by redundant mechanisms that are critical for the survival of our species. It will be the goal of the following decade to shed new light on these complex and essential pathways.

Correlation between inflammatory markers and insulin resistance in pregnancy

Gestational diabetes mellitus (GDM) is associated with an increased risk of postpartum type 2 diabetes mellitus and cardiovascular risk factors, such as obesity, hypertension, dyslipidaemia and systemic inflammation. We aimed to evaluate further lipid profile and inflammatory status assessed by high sensitive C-reactive protein (hsCRP) and TNF-α in GDM. Based on oral glucose tolerance testing, participants were stratified into three groups: normal 50 g glucose challenge test (GCT), normal 100 g glucose tolerance test (NOGTT) (control group) (n = 40); abnormal GCT NOGTT (glucose intolerance) (n = 37); and GDM (n = 39), defined by Carpenter and Coustan. The three groups did not demonstrate significantly different hsCRP levels (p = 0.4180) and lipid profile parameters, such as total cholesterol (p = 0.4210) and LDL-cholesterol (p = 0.4440) levels. Triglycerides (p = 0.0150) and atherogenic index of the plasma levels (p = 0.0280) were slightly higher in the GDM group. But, TNF-α levels increased significantly in the GDM (p < 0.0001) and in glucose intolerance (p = 0.0062) groups as compared with the control group. Among the metabolic syndrome components, insulin resistance was apparently associated with TNF-α, whereas dyslipidaemia was slightly associated with hsCRP because of the effects of maternal age on lipid markers. These findings suggest that TNF-α has a stronger correlation with pregnancy-associated insulin resistance than hsCRP at 24 to 28 weeks’ gestation.

Association between Omentin Levels and Insulin Resistance in Pregnancy

Omentin is a new adipokine secreted mainly from visceral adipose tissue. Serum omentin is found to be reduced in patients with impaired glucose tolerance, type 2 diabetes mellitus, obesity and insulin resistant states. Despite the fact that pregnancy is also characterized with hyperinsulinemia, literature is lacking about data of omentin levels and its association with insulin resistance in pregnant women. We aimed to evaluate the association of omentin levels and insulin resistance in pregnant women and to compare these levels with those of non-pregnant, non-diabetic women. Uncomplicated pregnant women who admit to our outpatient clinics for routine follow-up were included in the study group. Non-pregnant women without diabetes mellitus were served as control group. Fasting glucose, insulin, omentin levels and HOMA IR were recorded. SPSS 15.0 for Windows was used for statistical analysis. There were 36 pregnant women in the study group and 37 healthy, non-pregnant women in the control group. Serum omentin and fasting glucose levels were significantly decreased and fasting insulin was significantly increased in the study group compared to control group. Omentin might be an indicator of insulin resistance in pregnant women. Larger prospective studies are needed to claim whether omentin can have a clinical use for diagnosis of gestational diabetes mellitus.

Programming of fetal insulin resistance in pregnancies with maternal obesity by ER stress and inflammation.

The global epidemics of obesity during pregnancy and excessive gestational weight gain (GWG) are major public health problems worldwide. Obesity and excessive GWG are related to several maternal and fetal complications, including diabetes (pregestational and gestational diabetes) and intrauterine programming of insulin resistance (IR). Maternal obesity (MO) and neonatal IR are associated with long-term development of obesity, diabetes mellitus, and increased global cardiovascular risk in the offspring. Multiple mechanisms of insulin signaling pathway impairment have been described in obese individuals, involving complex interactions of chronically elevated inflammatory mediators, adipokines, and the critical role of the endoplasmic reticulum (ER) stress-dependent unfolded protein response (UPR). However, the underlying cellular processes linking MO and IR in the offspring have not been fully elucidated. Here, we summarize the state-of-the-art evidence supporting the possibility that adverse metabolic postnatal outcomes such as IR in the offspring of pregnancies with MO and/or excessive GWG may be related to intrauterine activation of ER stress response.

Lipoprotein(a) is not related to markers of insulin resistance in pregnancy.

BackgroundDyslipidemia, a major risk factor for cardiovascular disease is a common finding in patients with type 2 diabetes and among women with gestational diabetes. Elevated levels of lipoprotein(a) [Lp(a)] are linked to increased risk of cardiovascular disease. However, its relationship with insulin resistance, type 2 diabetes and gestational diabetes is controversial and unproven. Here we aimed to clarify whether Lp(a) levels are associated with insulin sensitivity in pregnancy.MethodsSixty-four women with gestational diabetes and 165 with normal glucose tolerance were enrolled in the study. Fasting Lp(a) serum levels were measured in all women at 24–28 weeks of gestation.ResultsIn pregnancy, there was no significant difference in serum Lp(a) concentrations between the two groups. Its level did not correlate with markers of insulin resistance (HOMA-IR), insulin sensitivity (HOMA-S%), pancreatic beta-cell function (HOMA-B%) and insulin sensitivity in dynamic conditions (OGIS). In addition, fasting glucose and insulin levels and those throughout an oral glucose tolerance test were independent of Lp(a) concentrations in our study group.ConclusionsLp(a) levels in pregnant women do not differ with respect to the presence or absence of gestational diabetes. Although influenced by some components of the lipid profile, such as triglycerides and HDL-C, insulin resistance in pregnancy is not affected by Lp(a).

Umbilical artery serum chitotriosidase concentration in pregnancies complicated by preeclampsia and relationship between chitotriosidase levels and fetal blood flow velocity

Objective: To evaluate the significance of umbilical cord chitotriosidase concentrations in pregnancies with mild preeclampsia and explore the relationship between fetal chitotriosidase levels and fetal blood flow velocity. Method: The study population included control group (n = 40) and study group with mild preeclampsia (n = 40). Umbilical cord blood samples were collected immediately after delivery. Umbilical artery (UA) flow velocity waveform was determined just before delivery. Results: Umbilical cord chitotriosidase levels and UA S/D rate were significantly high in preeclamptic group. Conclusion: Chitotriosidase may be useful biochemical marker of fetal compromise that reflects the severity of fetoplacental blood flow resistance in pregnancies complicated by preeclampsia.

Treatment of Severe Insulin Resistance in Pregnancy With 500 Units per Milliliter of Concentrated Insulin

To evaluate glycemic control and pregnancy outcomes among pregnant women with severe insulin resistance treated with 500 units/mL concentrated insulin. Retrospective analysis of gravid women with severe insulin resistance (need for greater than 100 units of insulin per injection or greater than 200 units/d) treated with either 500 units/mL concentrated insulin or conventional insulin therapy. We performed a two-part analysis: 1) between gravid women treated with and without 500 units/mL concentrated insulin; and 2) among gravid women treated with 500 units/mL concentrated insulin, comparing glycemic control before and after its initiation. Seventy-three pregnant women with severe insulin resistance were treated with 500 units/mL concentrated insulin and 78 with conventional insulin regimens. Patients treated with 500 units/mL concentrated insulin were older and more likely to have type 2 diabetes mellitus. Average body mass index was comparable between both groups (38.6 compared with 40.4, P=.11) as were obstetric and perinatal outcomes and glycemic control during the last week of gestation. Within the 500 units/mL concentrated insulin cohort, after initiation of this medication, fasting and postprandial blood glucose concentrations improved. However, the rates of blood glucose values less than 60 mg/dL and less than 50 mg/dL were higher in the 500 units/mL concentrated insulin group after initiation than before, 4.8% compared with 2.0% (P<.01) and 2.0% compared with 0.7% (P<.01), respectively. The use of 500 units/mL concentrated insulin in severely obese insulin-resistant pregnant women confers similar glycemic control compared with traditional insulin regimens but may increase the risk of hypoglycemia. II.

Prescription patterns and drug use among pregnant women with febrile Illnesses in Uganda: a survey in out-patient clinics

BackgroundMalaria is a public health problem in Uganda; affecting mainly women and children. Effective treatment has been hampered by over-diagnosis and over-treatment with anti-malarial drugs among patients presenting with fever. In order to understand the effect of drug pressure on sulfadoxine-pyrimethamine (SP) resistance in pregnancy, a sample of pregnant women presenting with fever in out–patient clinics was studied. The main objective was to assess prescription patterns and drug use in pregnancy especially SP; and draw implications on the efficacy of SP for intermittent preventive treatment of malaria in pregnancy (IPTp).MethodsA total of 998 pregnant women with a history of fever were interviewed and blood samples taken for diagnosis of malaria and HIV infections. Data were captured on the drugs prescribed for the current febrile episode and previous use of drugs especially SP, anti-retroviral drugs (ARVs) and cotrimoxazole.ResultsFew pregnant women, 128 (12.8%) were parasitaemic for P.falciparum; and of these, 72 (56.3%) received first-line treatment with Artemether-lumefantrine (Coartem®) 14 (10.9%) SP and 33 (25.8%) quinine. Of the parasite negative patients (non-malarial fevers), 186 (21.4%) received Coartem, 423 (48.6%) SP and 19 (2.1%) cotrimoxazole. Overall, malaria was appropriately treated in 35.5% of cases. Almost all febrile pregnant women, 91.1%, were sleeping under a mosquito net. The majority of them, 911 (91.3%), accepted to have an HIV test done and 92 (9.2%) were HIV positive. Of the HIV positive women, 23 (25.0%) were on ARVs, 10 (10.9%) on cotrimoxazole and 30 (32.6%) on SP. A significant proportion of women, 40 (43.5%), were on both SP and cotrimoxazole. Age and occupation were associated with diagnosis and treatment of malaria and HIV infections.ConclusionThere is inappropriate treatment of malaria and non-malarial fevers among pregnant women in these facilities. This is due to non-adherence to the guidelines. Over-prescription and use of anti-malarial drugs, especially SP may have implications on resistance against SP for malaria prevention in pregnancy. The policy implications of these findings are to evaluate SP efficacy as IPTp; and the need to enforce adherence to the current clinical treatment guidelines.

U-500R and aspart insulin for the treatment of severe insulin resistance in pregnancy associated with pregestational diabetes

Severe insulin resistance as a complication of diabetes in pregnancy is seen with increasing frequency. Treatment with large doses of insulin (>300 units perday) can be practically difficult. A woman with preexisting Type 2 diabetes mellitus and poor glycemic control presented in early pregnancy requiring over 1000 units of insulin daily. She was transitioned to subcutaneous U-500 (concentrated regular insulin) in combination with a rapid-acting insulin analog achieving good glycemic control and good maternal and fetal outcomes. U-500R insulin in conjunction with a rapid-acting insulin analog can be used safely in early pregnancy to improve glycemic control in severe insulin resistance due to pregestational diabetes.

Adiponectin/leptin ratio and insulin resistance in pregnancy

Pregnancy is characterized by progressive insulin resistance. The present study evaluated whether the adiponectin/leptin ratio is associated with insulin resistance in pregnancy, since this ratio has been shown to be associated with insulin resistance in obesity, type 2 diabetes mellitus, metabolic syndrome and polycystic ovary syndrome. In this cross-sectional study, adiponectin and leptin concentrations were measured in pregnant women using enzyme-linked immunosorbent assays. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Mean ± SD age of the participants (n = 74) was 30.76 ± 4.27 years, mean ± SD gestational age was 26.81 ± 3.52 weeks and median body mass index (BMI) before pregnancy was 22.68 kg/m(2) (interquartile range 20.75-26.79 kg/m(2)). There was a significant correlation between the HOMA-IR and leptin concentration, but not between the HOMA-IR and adiponectin concentration. There was a significant inverse correlation between the HOMA-IR and adiponectin/leptin ratio. The adiponectin/leptin ratio was inversely correlated with BMI before pregnancy. The adiponection/leptin ratio inversely correlates with HOMA-IR in pregnancy.

Maternale Endothelfunktion in Schwangerschaft und Wochenbett – ultraschallgestützte longitudinale Erfassung mittels Flow Mediated Dilatation (FMD)

NO-triggered vasodilatation decreases peripheral vascular resistance in pregnancy. Using a noninvasive ultrasound technique, flow-mediated vasodilatation can be quantified. We used this technique to detect changes in endothelial function during pregnancy and postpartum. In a prospective longitudinal study 16 healthy pregnant women were assessed for flow-mediated dilatation of the brachial artery during pregnancy (first trimester T1<14th gestational week, second trimester T2 ≥14th-27th gestational week, third trimester T3 ≥28th gestational week) and postpartum (>6 weeks postpartum). As a control group, flow-mediated dilatation was determined in 19 healthy non-pregnant women. Flow-mediated dilatation (%) increased significantly in normal human pregnancy from the first trimester (T1 8.0±5.58 vs. T2 15.2±5.19, p<0.003) to the second trimester and reached its maximum in mid-trimester. Towards the end of pregnancy, flow-mediated dilatation decreased significantly (T2 vs. T3 9.15±3.61, p<0.004). Mean values of flow-mediated dilatation are significantly higher during the second and third trimester of pregnancy compared to non-pregnant controls (T2 vs. NP 6.17±4.39, p<0.001; T3 vs. NP, p<0.047). Postpartum flow-mediated dilatation decreased to values of early pregnancy. During pregnancy maternal endothelial function shows an increase in flow-mediated dilatation and then reverts postpartum. Using ultrasound-based measurement of flow-mediated dilatation, these physiological changes in pregnancy can be reliably detected.

Potential role of estradiol and progesterone in insulin resistance through constitutive androstane receptor

Normal pregnancy is characterized by insulin resistance, which contributes to the development of gestational diabetes mellitus and preeclampsia by incompletely understood mechanisms. The constitutive androstane receptor (CAR) may participate in insulin resistance in pregnancy, and sex steroids, estradiol (E(2)) and progesterone, may also be involved. We applied glucose and insulin tolerance tests and measured the expression of gluconeogenic and lipogenic genes in the livers of oophorectomized mice treated with E(2) and progesterone with or without CAR ligands. We also investigated how E(2) and progesterone affected CAR-mediated signaling and the activity of transcription factors in gluconeogenesis in vitro. Mice with the concentrations of E(2) and progesterone within normal physiological range during pregnancy exhibited increased insulin resistance along with increased expression of gluconeogenic and lipogenic genes, and CAR activation rescued the abnormal glucose metabolism. In HepG2 cells, CAR ligands suppressed the gluconeogenic and lipogenic gene expression in the presence of E(2) and/or progesterone. DNA affinity immunoblotting and chromatin immunoprecipitation assay revealed that CAR ligand enhanced the recruitment of the gluconeogenic transcription factors, forkhead box O1 (FOXO1) and hepatocyte nuclear factor 4α (HNF4α), but sex steroids suppressed these recruitments on the CAR responsive element. Moreover, CAR ligand suppressed the recruitment of FOXO1 and HNF4α on their responsive element in gluconeogenic gene promoters and E(2) and progesterone augmented these recruitments on their responsive element. Taken together, these findings suggest that the activation of CAR-mediated signaling may ameliorate insulin resistance under relatively high concentrations of E(2) and progesterone, which were compatible with pregnancy via decreased activities of transcription factors in gluconeogenesis in combination with CAR.

Retinol-binding protein 4 is not associated with insulin resistance in pregnancy

Retinol-binding protein 4 (RBP4) is an adipokine proposed to be specifically associated with insulin resistance (IR). We examined whether serum levels of RBP4 were associated with IR in pregnancy. One hundred seventy-two women with gestational diabetes mellitus (GDM) and 361 pregnant Thai women who did not have GDM but had a positive 50-g glucose challenge test result (plasma glucose level was ≥7.2 mmol/L after 1 hour) were enrolled. We measured fasting serum levels of RBP4 and assessed IR at a 100-g oral glucose tolerance test. We found a higher degree of IR in the GDM group compared with the non-GDM group, but serum RBP4 levels between the 2 groups were not different. Retinol-binding protein 4 levels were associated with serum triglyceride levels but were not associated with the degree of IR assessed by homeostasis model assessment or quantitative insulin sensitivity check index. Our results suggest that serum RBP4 levels in pregnancy are not associated with IR.

Lipid metabolism in normal pregnancy – a magnetic resonance spectroscopy pilot study

BackgroundGestational diabetes mellitus (GDM) affects 5% of pregnancies and is associated with poor obstetric outcome. The mechanism of insulin resistance in pregnancy is unclear but may be due to increased...

Circulating interleukin-6 concentrations during and after gestational diabetes mellitus

Recent studies have shown that high interleukin-6 (IL-6) secretion may aggravate insulin resistance in pregnancy and participate in the pathogenesis of gestational diabetes mellitus (GDM). The aim of this study was to determine whether the presence of GDM is associated with elevated IL-6 concentrations and whether this association remains after delivery, independent of body mass index. Longitudinal study. Hospital-based. Forty-seven women were screened for GDM with a 75g oral glucose tolerance test at 26.1±3.7 weeks of pregnancy following the Canadian Diabetes Association guidelines (20 GDM, 27 control subjects). Interleukin-6 levels were measured by ELISA at the time of GDM screening and two months post-partum. Interleukin-6 concentrations were significantly higher in women with GDM compared with control women at the time of GDM screening (1.47±0.72 vs. 0.90±0.32pg/mL, p≤0.01). Similar results were obtained two months post-partum, where IL-6 levels remained significantly higher in women with GDM compared with control women (1.88±0.85 vs. 1.41±0.87pg/mL, p≤0.05). Interleukin-6 concentrations were significantly correlated with the Matsuda insulin sensitivity index, measured at the two time points (r=-0.60, p≤0.01 and r=-0.34, p≤0.05). The Matsuda insulin sensitivity index was an independent and significant predictor of IL-6 concentrations at the time of GDM screening, explaining 35.6% of the variance (p≤0.0001) in this variable. IL-6 concentration measured at GDM screening was identified as an independent and significant predictor of post-partum IL-6 concentrations, explaining 28.6% of the variance (p≤0.001). These results show that GDM is associated with elevated IL-6 levels independent of obesity levels, both during pregnancy and after delivery.

Caffeine and Insulin Resistance in Pregnancy

Outside pregnancy, acute caffeine consumption is associated with insulin resistance. We investigated if during pregnancy plasma concentrations of caffeine and its metabolite, paraxanthine, were associated with insulin resistance. Caffeine, paraxanthine, glucose, and insulin were measured and insulin resistance estimated by homeostasis model assessment (HOMA) in banked samples from 251 fasting subjects at mean gestational age of 20.3 ± 2.0 weeks. Analysis of covariance and adjusted logistic regression were performed. Most (96.4%) women had caffeine and/or paraxanthine present. Caffeine concentrations in the upper two quartiles (>266 ng/mL) were associated with threefold higher odds of having higher insulin resistance estimated by log HOMA ≥75th percentile (third quartile odds ratio [OR], 3.02; 95% confidence interval [CI]: 1.21 to 7.54 and fourth quartile OR, 2.95; 95% CI: 1.19 to 7.31). Paraxanthine concentrations in the upper quartile (>392 ng/mL) were also associated with threefold higher odds of having higher insulin resistance (OR, 3.04; 95% CI: 1.28 to 7.25). Adjusted mean HOMA in the first caffeine-to-paraxanthine ratio quartile was 1.5 ± 2.2 versus 1.3 ± 2.3 in the fourth quartile ( P < 0.01). Both high caffeine and paraxanthine concentrations were associated with insulin resistance, but slow versus fast metabolism did not make an important difference.

815: Insulin resistance in pregnancy and maternal body mass

815: Insulin resistance in pregnancy and maternal body mass