Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment–insulin resistance index in the first trimester

Özçimen, Emel Ebru; Üçkuyu, Ayla; Çiftçi, Faika Ceylan; Yanık, Filiz; Bakar, Çoşkun

doi:10.1080/09513590801948416

Cited by 51 publications

(35 citation statements)

References 21 publications

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“…It was in line with data from questionnaires pointing to the fact that only 70% of pregnant woman consumed, more or less regularly, pharmaceutical preparations containing supplemental [15] g Upper limit of normal TV given by Gutekunst and Martin-Teichert [16] h Data (range) reported by Heitland and Köster [17] i Data (range) reported by Rodushkin and Odman [18] j Data (range) reported by Wang et al [5] k http://www.drugs.com/enc/sodium-urine.html (April 7, 2009) iodine, and, simultaneously, low habitual iodine intake. This means that present realization of iodine prophylaxis during gestation is still not optimal since a large number of pregnant women fail to meet dietary recommendations for iodine [21].…”

Section: Discussionsupporting

confidence: 82%

Iodine, Selenium, and Other Trace Elements in Urine of Pregnant Women

Szybiński

Walas

Zagrodzki

et al. 2010

Biol Trace Elem Res

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The purpose of this work was to determine trace element levels in urine and evaluate possible associations between urinary iodine concentration (UIC), other trace elements (Cr, Cu, Fe, Mn, Na, Se, Zn), toxic elements (Cd, Pb), anthropometrical measures (body weight and height), glycemic indices (serum insulin and glucose), and several parameters related to thyroid function (thyroid stimulating hormone, free thyroxine, antithyroid peroxidase antibodies, thyroid volume, and thyroid echogenicity) in pregnant women. One hundred sixty-nine participants were recruited. The whole study group, originating from Krakow region, comprised three subgroups belonging to three trimesters: I trimester (n = 28), II trimester (n = 83), and III trimester (n = 58). Trace elements were determined using inductively coupled plasma mass/(atomic emission) spectrometry. Partial least square model was used to reveal correlation structure between parameters investigated, as well as a possible causal relationship between dependent parameters and potentially explanatory parameters. Results obtained for trace and toxic elements in urine were comparable with results of other authors, although the study group was not homogenous. We confirmed (1) low iodine excretion in pregnant women, (2) the existence of statistically significant correlation between UIC and urinary selenium, and (3) lack of correlation between latter parameter and typical indices of thyroid function. Urinary selenium correlated with other urinary trace elements, but physiological significance of this finding remains uncertain. The fact that a large number of pregnant women fail to meet dietary recommendations for iodine is the major reason for concern.

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Section: Discussionsupporting

confidence: 82%

Iodine, Selenium, and Other Trace Elements in Urine of Pregnant Women

Szybiński

Walas

Zagrodzki

et al. 2010

Biol Trace Elem Res

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“…Such an effect may be particularly important in women at risk of GDM, since this patient population exhibits chronic insulin resistance that is believed to pre-date pregnancy (31,32). Indeed, as increased insulin resistance in 1 st trimester (which largely reflects the pre-gravid state) predicts a higher risk of developing GDM later in pregnancy (33,34), it is plausible that improving insulin sensitivity prior to pregnancy would reduce GDM risk.…”

Section: Discussionmentioning

confidence: 99%

Pre‐gravid physical activity and reduced risk of glucose intolerance in pregnancy: the role of insulin sensitivity

Retnakaran

Sermer

et al. 2009

Clinical Endocrinology

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Objective-Pre-gravid physical activity has been associated with a reduced risk of gestational diabetes mellitus (GDM), although neither the types of exercise nor the physiologic mechanisms underlying this protective effect have been well studied. Thus, we sought to study the relationships between types of pre-gravid physical activity and metabolic parameters in pregnancy, including glucose tolerance, insulin sensitivity and beta-cell function.Design/Patients/Measurements-851 women underwent a glucose challenge test (GCT) and a 3-hr oral glucose tolerance test (OGTT) in late pregnancy, yielding 4 glucose tolerance groups: (i) GDM; (ii) gestational impaired glucose tolerance (GIGT); (iii) abnormal GCT with normal glucose tolerance on OGTT (abnormal GCT NGT); and (iv) normal GCT with NGT on OGTT (normal GCT NGT). Pre-gravid physical activity was assessed using the Baecke questionnaire, which measures (i) total physical activity and (ii) its 3 component domains: work, non-sport leisure-time, and vigorous/sports activity.Results-Glucose tolerance status improved across increasing quartiles of pre-gravid total physical activity (p=0.0244). Whereas neither work nor non-sport leisure-time activity differed between glucose tolerance groups, pre-gravid vigorous/sports activity was significantly higher in women with normal GCT NGT compared to women with (i) abnormal GCT NGT (p=0.0018), (ii) GIGT (p=0.0025), and (iii) GDM (p=0.0044). In particular, vigorous/sports activity correlated with insulin sensitivity (measured by IS OGTT ) (r=0.21,p<0.0001). Furthermore, on multiple linear regression analysis, pre-gravid vigorous/sports activity emerged as a significant independent predictor of IS OGTT in pregnancy (t=4.97,p<0.0001). CIHR Author Manuscript CIHR Author Manuscript CIHR Author ManuscriptConclusions-Pre-gravid vigorous/sports activity is associated with a reduced risk of glucose intolerance in pregnancy, an effect likely mediated by enhanced insulin sensitivity.

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“…It is probably chronic in nature [4,5,7] and is associated with an increased risk to the mother and child [4]. Recent studies indicate a direct [8] and indirect [9] relationship between the insulin resistance indices in the first trimester of pregnancy and the risk of GDM development, as well as risk of macrosomy.…”

Section: Introductionmentioning

confidence: 99%

Insulin resistance as estimated by the homeostatic method at diagnosis of gestational diabetes: estimation of disease severity and therapeutic needs in a population-based study

et al. 2013

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BackgroundChronic insulin resistance, exacerbated in the course of pregnancy, is an important pathophysiologic mechanism of gestational diabetes mellitus (GDM). We hypothesise that the degree of insulin resistance, assessed at diagnosis of GDM, is a parameter of its pathophysiologic heterogeneity and/or severity. Thus, it offers potential to open new avenues for the personalization of therapy in affected women.Methods1254 Polish Caucasian women with GDM were recruited into the study. The following parameters were assessed in the course of the study: body mass index (BMI), parity, weight gain during pregnancy, glycated haemoglobin, glucose level during an oral glucose tolerance test (OGTT), insulin, insulin resistance and insulin secretion. The severity of GDM was assessed based on insulin use and daily insulin dose during gestation. In order to evaluate insulin secretion and insulin resistance the homeostatic method was used (HOMA-B and HOMA-IR, respectively). We compared all the metabolic parameters and methods of treatment of GDM in women subdivided by quartiles of insulin resistance.ResultsThe HOMA-IR in the whole population ranged from 0.34 to 20.39. The BMI, fasting insulin, fasting glucose and insulin dose per day increased along with increasing quartiles (HOMA-IR > 1.29). We observed a decrease of HOMA-B in the third quartile (1.92-2.89) compared with the first quartile (0.34-1.29). Insulin treatment was associated with HOMA-IR (<1.29 vs. >2.89), OR: 3.37, fasting glucose (≤6.11 vs. >6.11 mmol/dl), OR: 2.61, age (≤30 vs. >30 y. o.), OR: 1.54, and BMI (<25 vs. ≥25 kg/m2), OR: 1.45. Maximum insulin dose was associated with HOMA-IR, OR: 2.00, after adjustment for family history of diabetes, and 2-h OGTT glucose.ConclusionInsulin resistance assessed by the HOMA index at diagnosis is associated with the severity and pathophysiological heterogeneity of GDM. A HOMA-IR >1.29 points to the major role of insulin resistance, indicating the need for a treatment aimed at improving tissue sensitivity to insulin. A HOMA-IR 1.29-2.89 suggests reduced insulin secretion, which is an indication for the introduction of insulin therapy. A HOMA-IR >2.89 indicates insufficient compensation for insulin resistance, which suggests the need for a treatment aimed at improving susceptibility of tissues to insulin combined with insulin therapy.

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Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment–insulin resistance index in the first trimester

Abstract: Accepting patients whose HOMA-IR value is higher than 2.60 in the first trimester seems to be a good method to predict GDM.

Cited by 51 publications

References 21 publications

Iodine, Selenium, and Other Trace Elements in Urine of Pregnant Women

Iodine, Selenium, and Other Trace Elements in Urine of Pregnant Women

Pre‐gravid physical activity and reduced risk of glucose intolerance in pregnancy: the role of insulin sensitivity

Insulin resistance as estimated by the homeostatic method at diagnosis of gestational diabetes: estimation of disease severity and therapeutic needs in a population-based study

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