Severe Insulin Resistance Linked to Complications of Pregnancy and Birth 

A study of women with gestational diabetes has demonstrated that insulin resistance is associated with an increased risk for adverse outcomes in pregnancy and birth for mothers and newborns. "It has been shown that gestational diabetes increases risk for pregnancy and birth complications," Dr. Khovidhunkit explained. "In our study we aimed to find out whether insulin resistance is also linked to poor outcomes in pregnant mothers and newborns."

The trial enrolled 538 pregnant women who responded positively to a glucose challenge test. Dr. Khovidhunkit and his colleagues obtained fasting plasma insulin levels for each participant and administered an oral glucose tolerance test. In addition, the researchers used the homeostasis model assessments of insulin resistance (HOMA1-IR and HOMA2-IR) to evaluate levels of insulin resistance and to classify participants as having low, moderate, or high insulin resistance.

Women with gestational diabetes mellitus (n = 172) as determined by oral glucose tolerance testing were more likely to have higher levels of fasting plasma glucose, fasting plasma insulin, and insulin resistance vs women who passed the oral glucose tolerance test.

The highest tertile of insulin resistance as measured by HOMA1-IR was associated with a 41% (95% confidence interval [CI], 1.61 – 1.71) increase in the relative risk for maternal complications compared with the lowest tertile. Dr. Khovidhunkit attributed the bulk of the increase to higher rates of cesarean delivery. In addition, infants born to women with the highest level of insulin resistance were 75% (95% CI, 1.11 – 2.76; P = .01) more likely to have macrosomia, hypoglycemia, and other complications of birth compared with infants born to women with the lowest insulin resistance.

Although the HOMA test for insulin resistance is not currently part of the suite of tests conducted during pregnancy, Dr. Khovidhunkit said the ease and speed of the test should make it a desirable alternative to traditional testing for gestational diabetes. "The standard oral glucose tolerance test is time consuming, and some women cannot tolerate it because of nausea and vomiting," he explained. "We have found that severe insulin resistance during pregnancy is linked to poor outcomes, but a simple blood test may be a new tool in predicting these outcomes."

Glenn Cunningham, MD, moderator of the session and a professor of medicine and professor of molecular and cellular biology at Baylor College of Medicine in Houston, Texas, said the study could provide important information to help clinicians identify and care for at-risk women. "For 20 or 25 years we have been aware that glucose control is very important in terms of both maternal and fetal outcomes of pregnancy, and to a great deal, we’ve been able to improve this and reduce the risk both to the mother and to the fetus," Dr. Cunningham explained. "But there are situations where this could certainly be improved."

Dr. Khovidhunkit noted that it is possible for women to have high insulin resistance without having gestational diabetes, but none were identified in this trial. He suggested that further studies will be needed in additional patient populations to determine whether HOMA would be a suitable replacement for oral glucose tolerance testing.

Practice Pearls 

• Compared with pregnant women in the lowest tertile of insulin resistance as measured by HOMA1-IR, those in the highest tertile had a 41% increase in the relative risk for maternal complications. Most of this increase was attributed to higher rates of cesarean delivery. All of the women in this trial who had high insulin resistance also had gestational diabetes. The ease and speed of HOMA1-IR may make it a desirable alternative to traditional testing with an oral glucose tolerance test for gestational diabetes.
• Compared with infants born to women in the lowest tertile of insulin resistance, those born to women with the highest level of insulin resistance were 75% more likely to have macrosomia, hypoglycemia, and other complications.

ENDO 2008, the Endocrine Society 90th Annual Meeting: P3-532. Presented June 17, 2008.

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DID YOU KNOW:
Pharmacists Improve Blood Pressure Control: Patients with hypertension who monitored their blood pressure from home and received Web-based pharmacist care showed greater improvement in blood pressure control than patients who received usual care, according to a study.  See this weeks’ Item #15

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