High Fasting Insulin Levels and Insulin Resistance May Be Linked to Idiopathic Recurrent Pregnancy Loss: A Case-Control Study

Abstract

Objective. Patients with more than two spontaneous pregnancy losses are diagnosed with recurrent pregnancy loss. The aim of this study was to evaluate the IR (insulin resistance) in patients with idiopathic recurrent pregnancy loss. Material and Method. A single center, case control study was performed on one hundred eighteen women divided into case group (with at least two pregnancy losses, earlier than 20 weeks of gestation, and negative for the recurrent pregnancy loss testing) and control group (with at least one live birth, no pregnancy loss). FG (fasting glucose) and FI (fasting insulin) were determined for all patients. IR was evaluated by HOMA-IR index. Results. There were not significant differences between the mean age and BMI in cases and controls (P > 0.05). Fasting glucose was significantly higher in the control group (85.6 versus 79.8 P < 0.01), but fasting insulin (15.24 versus 12.83, P < 0.001) and HOMA-IR (2.98 versus 2.69, P < 0.05) were significantly higher in the case group. Conclusion. In women with idiopathic recurrent pregnancy loss FI and IR are higher than those in women without spontaneous abortion.

ESHRE guideline: recurrent pregnancy loss

“…Strong ⊕⊕⊕○Abnormal thyroid-stimulating hormone (TSH) and thyroid peroxidase [TPO]-antibody levels should be followed up by thyroxine (T4) testing in women with RPL (van den Boogaard et al , 2011; Lazarus et al , 2014). Strong ⊕⊕⊕○Assessment of polycystic ovary syndrome (PCOS), fasting insulin and fasting glucose is not recommended in women with RPL to improve next pregnancy prognosis (Rai et al , 2000; Craig et al , 2002; Wang et al , 2011; Maryam et al , 2012; Chakraborty et al , 2013; Ispasoiu et al , 2013; Kazerooni et al , 2013). Strong ⊕⊕○○Prolactin testing is not recommended in women with RPL in the absence of clinical symptoms of hyperprolactinemia (oligo/amenorrhoea) (Bussen et al , 1999) (Triggianese et al , 2015) (Li et al , 2013).…”

Early or late pregnancy loss and development of clinical cardiovascular disease risk factors: a prospective cohort study

“…(29) Likewise, chronic systemic inflammation has been linked to both recurrent pregnancy loss and the development of clinical CVD risk factors. (30) Evidence suggests that endocrine disorders, like impaired glucose tolerance and PCOS, are associated with higher risk of spontaneous pregnancy loss,(31, 32) T2D, and dyslipidemia. In our analyses, adjustment for menstrual cycle length and irregularity did not alter conclusions, but menstrual cycle pattern may be an insufficient proxy for PCOS.…”

Prokineticin 1 is up‐regulated by insulin in decidualizing human endometrial stromal cells

“…Metabolic disorders such as PCOS, obesity and insulin resistance are associated with elevated risk of both miscarriage, including recurrent pregnancy loss [19, 21-23, 27, 28] and pre-eclampsia [18,30]. Furthermore, a direct relationship was suggested between hyperinsulinaemia-a condition that can be present in these metabolic disorders-and early pregnancy loss/recurrent miscarriage [20,23,26,27,31], as well as pre-eclampsia [24,25,29].…”

“…Insulin resistance leading to secondary hyperinsulinaemia has been suggested to be of importance for pregnancy complications including miscarriage, recurrent pregnancy loss and pre-eclampsia in metabolic disorders such as polycystic ovary syndrome (PCOS) and obesity [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. However, the underlying mechanisms are poorly understood.…”