Higher insulin resistance in gestational diabetes predicts preterm birth risk
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Women with gestational diabetes are more likely to deliver preterm if they have higher vs. lower insulin resistance, and this association may be influenced by BMI and weight gain during pregnancy, according to findings published in the Journal of Diabetes.
“Our study indicates that insulin resistance in the late second trimester is associated with adverse pregnancy outcomes, especially for preterm delivery in women with gestational diabetes,” Hui-Xia Yang, MD, PhD, of the department of obstetrics and gynecology at Peking University First Hospital in Beijing, and colleagues wrote. “In addition, prepregnancy BMI and weight gain before diagnosis of gestational diabetes are independent risk factors for the insulin resistance in the late second trimester.”
Yang and colleagues assessed insulin resistance, HbA1c, and glucose, lipid and triglyceride levels via blood samples for 2,647 women (mean age, 32.31 years) who were diagnosed with gestational diabetes between 2014 and 2016. The researchers also assessed weight before pregnancy, at gestational diabetes diagnosis and delivery, and used medical records to identify instances of large for gestational age, small for gestational age, macrosomia, preterm birth and cesarean section.
Women with gestational diabetes and the highest levels of insulin resistance (HOMA-IR > 3.238 mmol/L x U/mL) were more likely than those with the lowest levels to deliver preterm when adjustments such as prepregnancy BMI and pregestational diabetes diagnosis weight gain were included (OR = 3.2; 95% CI, 1.68-6.12). Before these adjustments, women with the highest levels of insulin resistance were also more likely than those with the lowest levels to have a cesarean section (OR = 1.4; 95% CI, 1.12-1.74), large for gestational age offspring (OR = 2.46; 95% CI, 1.5-4.01) and offspring with macrosomia (OR = 2.33; 95% CI, 1.49-3.64).
The researchers observed stronger associations for women with a BMI between 18.5 kg/m2 and less than 24 kg/m2, which was considered normal weight for this population. Among these women, those with the highest levels of insulin resistance were more likely than those with the lowest levels to deliver preterm (OR = 5.98; 95% CI, 2.29-15.58), have offspring with macrosomia (OR = 2.05; 95% CI, 1.04-4.02) and have a large for gestational age birth (OR = 2.49; 95% CI, 1.14-5.44) even after incorporating adjustments.
“Women should be encouraged and educated to keep their BMI within the normal range before conception and avoid excess gain of weight before the late trimester. Any treatment to reduce the BMI may be beneficial to decrease insulin resistance,” the researchers wrote. “For patients with newly diagnosed gestational diabetes, it might be necessary to evaluate the severity of their insulin resistance, and for those with severer insulin resistance, stricter glycemic monitoring should be suggested after diagnosis to reduce gestational diabetes-associated adverse outcomes.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.
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