CORRELATION OF FASTING INSULIN AND HOMA-IR IN EARLY PREGNANCY WITH THE DEVELOPMENT OF GESTATIONAL HYPERTENSION AND GDM
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Keywords
HOMA-IR, Gestational Diabetes Mellitus, Gestational Hypertension, Insulin Resistance
Abstract
Background: Gestational Diabetes Mellitus (GDM) and Gestational Hypertension (GH) are common pregnancy complications. They are associated with underlying maternal metabolic derangement and increased insulin resistance. The objective of this study was to evaluate the predictive value of early first trimester fasting insulin and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) for the subsequent development of GDM and GH in a Central Indian population.
Methods:The prospective observational cohort study included 60 pregnant women who presented between 10 and 14 weeks gestation at a tertiary care center. Women with pre-existing metabolic or hypertensive disorders were not included. At the first visit, demographic data, Fasting Plasma Glucose and Fasting Serum Insulin were recorded and HOMA-IR was calculated. Participants were followed-up during their pregnancy to diagnose onset of GDM (using a 75g, 2-hour OGTT at 24-28 weeks) and Gestational Hypertension.
Résults: Among the 60 participants, 41 had a normal pregnancy, 11 developed GDM and 8 developed GH. Fasting insulin and HOMA-IR were significantly higher in women who subsequently developed GDM (HOMA-IR : 3.34 ± 0.88) and GH (HOMA-IR : 2.84 ± 0.72) compared to women with a normal pregnancy (HOMA-IR : 1.53 ± 0.45) in the first trimester (p < 0.001). Also, first-trimester HOMA-IR was strongly positively associated with 2-h OGTT glucose levels (r = 0.62, p < 0.001) and third-trimester peak systolic blood pressure (r = 0.54, p < 0.001).
Conclusion:Fasting insulin and HOMA-IR levels in the first trimester are with high sensitivity and specificity early biochemical predictors of development of Gestational Diabetes Mellitus and Gestational Hypertension. Routine early screening with HOMA-IR can help identify patients at high risk to implement preventive interventions in a timely manner and improve maternal and perinatal outcomes.
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