International Journal of Diabetes Mellitus
Volume 2, Issue 1 , Pages 3-9, April 2010

Clinical assessment of insulin action during late pregnancy in women at risk for gestational diabetes: Association of maternal glycemia with perinatal outcome

  • Karen E. Elkind-Hirsch

      Affiliations

    • Woman’s Health Research Department, Woman’s Hospital, Baton Rouge, LA, United States
    • Corresponding Author InformationCorresponding author. Address: Woman’s Health Research Department, Woman’s Hospital, 9050 Airline Highway, Baton Rouge, LA 70815, United States. Tel.: +1 225 231 5278; fax: +1 225 924 8225.
    • ,
  • Beverly W. Ogden

      Affiliations

    • Woman’s Pathology Laboratory, Woman’s Hospital, Baton Rouge, LA, United States
    • ,
  • Carmen J. Darensbourg

      Affiliations

    • Woman’s Health Research Department, Woman’s Hospital, Baton Rouge, LA, United States
    • ,
  • Brett L. Schelin

      Affiliations

    • Woman’s Pathology Laboratory, Woman’s Hospital, Baton Rouge, LA, United States

Received 1 September 2009; accepted 16 December 2009. published online 18 January 2010.

Abstract 

Objective

We prospectively evaluated differences in fasting- and oral glucose tolerance test (OGTT)-derived indices of insulin action in Caucasian (Cau) and African-American (AA) pregnant women and compared them with obstetric outcomes.

Study design

IRB-approved prospective study in 171 pregnant women undergoing a 3-h OGTT. Mathematical modeling was used to evaluate insulin response, insulin activity and glucose tolerance in fasting and postglucose ingestion state. Insulin sensitivity indices derived from fasting (HOMA-IR) and glucose-stimulated values (SIOGTT) were compared. An insulin sensitivity-secretion index (IS-SI) was calculated from the product of the SIOGTT and early-phase insulin secretion.

Results

Forty-nine patients had gestational diabetes (GDM), 28 had gestational impaired glucose tolerance (GIGT) and 94 had normal glucose tolerance after an abnormal glucose challenge test (NGT-abnGCT). Insulin sensitivity was lowest in women with GDM. In all groups, pregnant AA women were significantly more insulin resistant than Cau women, based on both HOMA-IR and SIOGTT, but had enhanced insulin secretion compared to their Cau counterparts. The mean IS-SI progressively improved for all women from GDM to GIGT to NGT-abnGCT. Women with NGT-abnGCT had a higher prevalence of large-for-gestational age (LGA) newborns and significantly higher cesarean section rate.

Discussion

Insulin measures along with glucose determinations during OGTT testing in pregnant women at risk for diabetes provide valuable information that varies according to race. We observed that pregnant women with a lesser degree of glucose tolerance abnormality during pregnancy who receive no intervention have a higher risk for LGA infants and significantly increased C-section rate (ClinicalTrials.gov number, NCT006874791).

Keywords: Gestational diabetes, Insulin sensitivity, Insulin secretion, Racial disparity, Perinatal outcome

 

PII: S1877-5934(09)00063-0

doi:10.1016/j.ijdm.2009.12.006

International Journal of Diabetes Mellitus
Volume 2, Issue 1 , Pages 3-9, April 2010

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