Central Obesity Increases the Risk of Gestational Diabetes Partially Through Increasing Insulin Resistance

Abstract

Objective This study examined the associations of central obesity measures, waist to hip ratio (WHR) and waist circumference (WC), in early pregnancy with subsequent risk of gestational diabetes mellitus (GDM) and evaluated the potential mediating role of insulin resistance markers. Methods Within the prospective Pregnancy Environment and Lifestyle Study cohort of 1,750 women, WC and hip circumference were measured at gestational weeks 10 to 13. In a nested case‐control study within the cohort, 115 GDM cases and 230 controls had fasting serum insulin, homeostatic model assessment of insulin resistance (HOMA‐IR), and adiponectin measurements at gestational weeks 16 to 19. Poisson and conditional logistic regression models were used, adjusting for established risk factors for GDM, including prepregnancy overweight or obesity. Results For women with WHR < 0.85, one or more established risk factors increased GDM risk 1.99‐fold (95% CI: 0.99‐4.02). For women with WHR ≥ 0.85 but no established risk factors, GDM risk increased 2.41‐fold (95% CI: 1.14‐5.06), and in those with established risk factors it increased 6.22‐fold (95% CI: 3.49‐11.10). Similar but attenuated results were observed for WC ≥ 88 cm. Insulin, HOMA‐IR, and adiponectin levels mediated the WHR–GDM association by 9% to 11%; corresponding mediation proportions for the WC–GDM association were 35% to 41% (all P < 0.04). Conclusions Central obesity in early pregnancy represented a high‐risk phenotype for GDM independent of other risk factors, including overweight or obesity, and may inform early screening and prevention strategies.

β-Cell function or insulin resistance was associated with the risk of type 2 diabetes among women with or without obesity and a history of gestational diabetes

“… 28 29 A recent study found that central obesity was strongly associated with IR, which was calculated by HOMA-IR, and increased the risk of gestational diabetes in early pregnancy. 30 Alptekin et al indicated that in women with BMI>25.95 kg/m 2 and HOMA-IR>2.08 during pregnancy, weight loss may help reduce the risk of GDM. 31 An observation has demonstrated that during the first pregnancy trimester, HOMA-IR>2.60 can predict GDM.…”

Relationship between Maternal Central Obesity and the Risk of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Cohort Studies

“…From the included studies, 2,226 and 25,449 pregnant women were GDM and non-GDM, respectively. A total of seven studies were from non-Asian countries [14,[16][17][18][20][21][22], and four were from Asia [13,15,19,23].…”

“…In these studies, nine studies reported the relationship between maternal central obesity and GDM in the first trimester [13][14][15][16][18][19][20][21] and two reported the relationship in the second trimester [22,23]. Six studies adopted WC or WHR [13][14][15][16][17][18], two used visceral adipose tissue depth (VAT) [20,21], two used BFI or FMP [22,23], and one used maternal SFT to measured maternal central obesity [19]. Most studies matched or adjusted for maternal age (n = 10) and BMI (n = 9).…”

“…Hence, maternal central obesity is significant and can reflect fat distribution or the proportion of adipose to nonadipose tissue [12]. Existing research shows that maternal central obesity has many evaluation measures, such as waist circumference (WC)/waist-hip ratio (WHR) [13][14][15][16], abdominal subcutaneous fat thickness (SFT) [17][18][19][20][21], and body fat index (BFI) [22,23], but the predictive value of these measures is not clear. The measurement accuracy and precision of WC are difficult to guarantee as it can only evaluate the condition of abdominal fat tissue, which has certain limitations [24,25].…”

Crosstalk Among Circadian Rhythm, Obesity and Allergy

“…The increase in the number of people with obesity is a global public health concern, which poses a substantial socioeconomic burden. Furthermore, epidemiologic studies have indicated that obesity increases the risk of diabetes, insulin resistance, metabolic syndrome, and cardiovascular disease [21,22]. Many studies in humans have shown that obesity associates with disturbances of biological rhythms, such as those governing sleep and food intake.…”