Profile of Insulin Resistance of Pregnant Women at Late Third Trimester in Nigeria

Abstract

Background: Exaggerated level of insulin resistance (IR) is associated with poor pregnancy outcomes. Identifying affected women may forestall these outcomes. There are few reports on IR and its predictors among pregnant women in Nigeria. Aim: To determine the profile of IR, using the homeostatic model assessment of insulin resistance (HOMA-IR), and its predictors among parturient Nigerian women in third trimester. Patients and Methods: A cross-sectional baseline data of healthy pregnant women in third trimester, consecutively recruited into a cohort study that evaluated IR and neonatal outcomes at a tertiary maternity. Sociodemographic and clinical data were obtained. Fasting venous blood was analyzed for glucose and insulin and HOMA-IR was calculated. Results: We consecutively recruited 401 healthy pregnant women between 28 and 41 weeks [means ± SD = 37.4 ± 0.8 weeks]; mean age 31.52 ± 4.3 years (range: 20-41 years). Median (IQR) HOMA-IR was 1.15 (0.63, 1.96; range: 0.02–11.73). Binary multivariable logistic regression showed overweight- [aOR (95% CI) = 3.29 (1.18, 9.13)], hyperglycemia- [aOR (95% CI) = 2.98 (1.19, 6.90)], and hypertension as independent predictors of IR [aOR (95% CI) = 2.85 (1.18, 6.90)]. Conclusion: Among nondiabetic Nigerian pregnant women in late third trimester, IR was independently associated with overweight, hypertension, and hyperglycemia. Control of adiposity is a potential target for control of IR and consequently its outcomes.

Association of maternal insulin resistance with neonatal insulin resistance and body composition/size: a prospective cohort study in a sub-Saharan African population

“…High maternal prepregnancy weight and excessive intrapregnancy weight gain are both independent risk factors for neonatal LGA or macrosomia [ 37 ]. Although we did not measure any of these variables, previous reports [ 19 , 20 ]. showed that late-trimester weight greater than 95 kg is an independent predictor of maternal IR.…”

“…The study involved a prospective cohort involving 401 singleton nondiabetic pregnant women recruited at the third trimester and followed up until birth at the Obstetrics & Gynaecology Department of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria [ 19 ]. We excluded those with chronic medical conditions including diabetes or hypertension.…”

“…We excluded those with chronic medical conditions including diabetes or hypertension. The baseline data of the participants were reported previously [ 19 ]. Herein, we report the findings of 150 mother-neonate dyads (before closure of the study due to fund limitation).…”

“…At recruitment, we used selfdesigned structured data collection forms to obtain maternal anthropometric (weight, height), demographic (age, education, occupation) and clinical (family history of diabetes) data from the participants or their medical records. Venous samples were obtained from mothers for fasting serum glucose (FSG) and insulin (FSI) assays, and HOMA-IR was estimated as [(FSI × FSG)/22.5)], as previously described [ 19 ]. Within 48 hours of birth, venous blood was collected from each infant within 3 hours of a feeding for serum glucose and insulin assays, and HOMAIR was calculated.…”

“…We [ 19 ] previously defined maternal overweight, hyperglycaemia, hyperinsulinaemia and elevated HOMA-IR as thirdtrimester weight ≥95 kg [ 20 ], FSG >91.0 mg/dL [ 21 ], FSI >20 μU/mL [ 22 ], and HOMA-IR >75th centile (corresponding to >1.96) [ 23 ]; similarly, we define elevated neonatal HOMA-IR as HOMAIR >75th centile. Measures of neonatal body size included birth weight and its categorical derivatives: SGA (weight-for-GA < 10th centile on INTERGROWTH-21st growth standards) [ 24 ], LGA (weight-for-GA > 90th centile), appropriatefor-gestational-age (AGA) (weight-for-GA between 10th and 90th centile), and macrosomia (birth weight > 3,999 g); birth length and its categorical derivative: stunting (birth length < 3rd centile); and HC and its categorical derivative: microcephaly defined as HC <3rd centile.…”