Insulin sensitivity, β cell function, and adverse pregnancy outcomes in women with gestational diabetes

Abstract

Background: The potential impact of b cell function and insulin sensitivity on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains uncertain. We aimed to investigate the association between b cell dysfunction, insulin resistance, and the composite adverse pregnancy outcomes. Methods: This observational study included 482 women diagnosed with GDM during pregnancy. Quantitative metrics on b cell function and insulin sensitivity during pregnancy were calculated using traditional equations. The association of b cell dysfunction and insulin resistance with the risk of the composite adverse pregnancy outcomes was investigated using multivariable-adjusted logistic regression models. Results: Multivariable-adjusted odds ratios (ORs) of adverse pregnancy outcomes across quartiles of homeostatic model assessment for insulin resistance (HOMA-IR) were 1.00, 0.95, 1.34, and 2.25, respectively (P for trend = 0.011). When HOMA-IR was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 1.34 (95% confidence interval 1.16-1.56) for each 1-unit increase in HOMA-IR. Multivariable-adjusted ORs of adverse pregnancy outcomes across quartiles of homeostatic model assessment for b cell function (HOMA-b) were 1.00, 0.51, 0.60, and 0.53, respectively (P for trend = 0.068). When HOMA-b was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 0.57 (95% CI 0.24-0.90) for each 1-unit increase in HOMA-b. However, other quantitative metrics were not associated with the composite adverse pregnancy outcomes. Conclusions: We demonstrated a significant association of b cell function and insulin sensitivity with the risk of adverse pregnancy outcomes. We have provided additional evidence on the early identification of adverse pregnancy outcomes besides the glycemic values.

Are insulin sensitivity and β-cell function associated with adverse pregnancy outcomes among women with gestational diabetes?

“…[27] Two Chinese studies also found that increasing IR in the late second trimester might be associated with an increased risk of adverse pregnancy outcomes in women with GDM. [28,29] In this issue of the Chinese Medical Journal, the study by Shen et al [30] assessed the association of b-cell function and insulin sensitivity with the risk of adverse pregnancy outcomes among Chinese women with GDM, and also evaluated the potential impact of different pathophysiologic patterns on adverse pregnancy outcomes of GDM. This observational study included 482 Chinese women diagnosed with GDM.…”