Metabolic characteristics and adverse pregnancy outcomes for women with hyperglycaemia in pregnancy as a function of insulin resistance

Emmanuel Cosson; Charlotte Nachtergaele; Eric Vicaut; Sopio Tatulashvili; Meriem Sal; Narimane Berkane; Sara Pinto; Emmanuelle Fabre; Amélie Benbara; Marion Fermaut; Angela Sutton; Paul Valensi; Lionel Carbillon; Hélène Bihan

doi:10.1016/j.diabet.2022.101330

Metabolic characteristics and adverse pregnancy outcomes for women with hyperglycaemia in pregnancy as a function of insulin resistance

Diabetes Metab. 2022 May;48(3):101330. doi: 10.1016/j.diabet.2022.101330. Epub 2022 Jan 31.

Authors

Affiliations

¹ AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France. Electronic address: emmanuel.cosson@aphp.fr.
² AP-HP, Unité de Recherche Clinique St-Louis-Lariboisière, Université Denis Diderot, Paris, France.
³ AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France.
⁴ AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France.
⁵ AP-HP, Avicenne and Jean Verdier Hospitals, Paris 13 University, Sorbonne Paris Cité, Biochemistry Department, Bobigny, France.
⁶ AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Obstetrics and Gynecology, Bondy, France.

PMID: 35114388
DOI: 10.1016/j.diabet.2022.101330

Abstract

Aim: Recent studies have shown that women with hyperglycaemia in pregnancy and insulin resistance have a greater risk of adverse pregnancy outcomes than women with normoglycaemic pregnancies. This study aimed to determine adverse pregnancy outcomes of women with hyperglycaemia in pregnancy only as a function of insulin resistance.

Methods: From a prospective cohort study, we included 1,423 women with hyperglycaemia in pregnancy whose insulin resistance was evaluated using homoeostatic model assessment for insulin resistance (HOMA-IR) when care was first provided for this condition. We compared the adverse pregnancy outcomes for different tertiles of HOMA-IR (intertertile range 1.9 and 3.3).

Results: Increasing HOMA-IR tertiles were positively associated with the rate of insulin therapy (tertile 1, 2 and 3: 32.7, 47.0 and 58.7%, P < 0.0001), caesarean section (23.7, 26.0 and 32.2%, respectively, P < 0.01), gestational hypertension (1.3, 2.8 and 5.4% respectively, P < 0.01), preeclampsia (1.5, 2.8 and 4.5% respectively, P < 0.05), large-for-gestational-age infant (13.3, 10.4 and 17.6% respectively, P < 0.05), and neonatal hypoglycaemia (0.8, 1.5 and 3.2% respectively, P < 0.05). Women in the 3rd HOMA-IR tertile were more likely to have insulin therapy (odds ratio 2.09 (95% interval confidence 1.61-2.71)), hypertensive disorders (2.26 (1.42-3.36)), and large-for-gestational-age infant (1.42 (1.01-1.99)) than those in the 1st and 2nd tertiles combined in multivariable logistic regression analyses adjusted for gestational age at HOMA-IR measurement, glycaemic status, age, body mass index, family history of diabetes, parity and ethnicity.

Conclusion: Despite suitable care and increased rates of insulin therapy during pregnancy, higher insulin resistance in women with hyperglycaemia in pregnancy was associated with a greater risk of adverse pregnancy outcomes.

Keywords: Diabetes in pregnancy; Gestational diabetes mellitus; HOMA-B, HOMA-IR; Oral glucose tolerance test; Pregnancy outcomes.

MeSH terms

Blood Glucose / metabolism
Cesarean Section
Diabetes, Gestational* / drug therapy
Diabetes, Gestational* / epidemiology
Diabetes, Gestational* / metabolism
Female
Glucose Tolerance Test
Humans
Hyperglycemia* / epidemiology
Infant, Newborn
Insulin / metabolism
Insulin / therapeutic use
Insulin Resistance*
Pregnancy
Pregnancy Outcome / epidemiology
Prospective Studies

Substances

Blood Glucose
Insulin