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Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR

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Abstract

Purpose

To determine the predictability of gestational diabetes mellitus (GDM) during the first trimester using the degree of insulin resistance and anthropometric measurements and to assign the risk of developing GDM by weight gained during pregnancy (WGDP).

Methods

A total of 250 singleton pregnancies at 7–12 gestational weeks were studied. Body mass index (BMI), waist/hip ratio (WHR), quantitative insulin sensitivity check index (QUICKI), homeostasis model assessment-insulin resistance (HOMA-IR) scores and WGDP were determined. The backward stepwise method was applied to estimate possible associations with GDM. Cutoff points were estimated using receiver operating characteristic curve analysis.

Results

GDM was found in 20 of 227 singleton pregnancies (8.8 %). The calculated HOMA-IR, QUICKI, BMI, WHR, WGDP, and parity were significantly associated with GDM. Logistic regression analyses showed that three covariates (HOMA-IR, BMI, WGDP) remained independently associated with GDM. It was calculated as OR 1.254 (95 % CI 1.006–1.563), AUC 0.809, sensitivity 90 %, specificity 61 % with cutoff = 2.08 for HOMA-IR; OR 1.157 (CI 1.045–1.281), AUC 0.723, sensitivity 80 %, specificity 58 % with cutoff = 25.95 for BMI; OR 1.221, (CI 1.085–1.374), AUC 0.654, sensitivity 80 %, specificity 46 % with cutoff = 4.7 for WGDP. Despite a HOMA-IR score of >3.1 in pregnant women, GDM was detected in only three of 29 patients (10.3 %) if WGDP was <4.7 kg at weeks 24–28.

Conclusions

First trimester screening for GDM can be achieved based on maternal anthropometric measurements and HOMA-IR. In particular, if BMI is >25.95 kg/m2 and the HOMA-IR score >2.08, controlling weight gain may protect against GDM.

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References

  1. Ferrara A, Kahn HS, Quesenberry CP, Riley C, Hedderson MM (2004) An increase in the incidence of gestational diabetes mellitus: Northern California, 1991–2000. Obstet Gynecol 103:526–533

    Article  PubMed  Google Scholar 

  2. Hunsberger M, Rosenberg KD, Donatelle RJ (2010) Racial/ethnic disparities in gestational diabetes mellitus: findings from a population-based survey. Womens Health Issues 20:323–328

    Article  PubMed  Google Scholar 

  3. Sobngwi E, Boudou P, Mauvais-Jarvis F, Leblanc H, Velho G, Vexiau P et al (2003) Effect of a diabetic environment in utero on predisposition to type 2 diabetes. Lancet 361:1861–1865

    Article  PubMed  Google Scholar 

  4. Sommer C, Morkrid K, Jenum AK, Sletner L, Mosdol A, Birkeland KI (2014) Weight gain, total fat gain and regional fat gain during pregnancy and the association with gestational diabetes: a population-based cohort study. Int J Obes Lond 38:76–81

    Article  CAS  PubMed  Google Scholar 

  5. Montoro MN, Kjos SL, Chandler M, Peters RK, Xiang AH, Buchanan TA (2005) Insulin resistance and preeclampsia in gestational diabetes mellitus. Diabetes Care 28:1995–2000

    Article  CAS  PubMed  Google Scholar 

  6. Colomiere M, Permezel M, Lappas M (2010) Diabetes and obesity during pregnancy alter insulin signalling and glucose transporter expression in maternal skeletal muscle and subcutaneous adipose tissue. J Mol Endocrinol 44:213–223

    Article  CAS  PubMed  Google Scholar 

  7. Lapolla A, Dalfrà MG, Mello G, Parretti E, Cioni R, Marzari C et al (2008) Early detection of insulin sensitivity and beta-cell function with simple tests indicates future derangements in late pregnancy. J Clin Endocrinol Metab 93(3):876–880

    Article  CAS  PubMed  Google Scholar 

  8. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419

    Article  CAS  PubMed  Google Scholar 

  9. Hedderson MM, Gunderson EP, Ferrara A (2010) Gestational weight gain and risk of gestational diabetes mellitus. Obstet Gynecol 115:597–604

    Article  PubMed  PubMed Central  Google Scholar 

  10. James PT, Leach R, Kalamara E, Shayeghi M (2001) The worldwide obesity epidemic. Obes Res 4:228–233

    Article  Google Scholar 

  11. Mora-Garcia GJ, Gomez-Camargo D, Mazenett E, Alario A, Fortich A, Gomez-Alegria C (2014) Anthropometric parameters’ cut-off points and predictive value for metabolic syndrome in women from Cartagena, Colombia. Salud Publica Mex 56:146–153

    PubMed  Google Scholar 

  12. Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G et al (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 85:2402–2410

    Article  CAS  PubMed  Google Scholar 

  13. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144:768–773

    CAS  PubMed  Google Scholar 

  14. Newbern D, Freemark M (2011) Placental hormones and the control of maternal metabolism and fetal growth. Curr Opin Endocrinol Diabetes Obes 18:409–416

    Article  CAS  PubMed  Google Scholar 

  15. International Association of D, Pregnancy Study Groups, Consensus P, Metzger BE et al (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682

    Article  Google Scholar 

  16. American Diabetes A (2011) Standards of medical care in diabetes–2011. Diabetes Care 34(Suppl 1):S11–S61

    Article  Google Scholar 

  17. Committee on Practice B-O (2013) Practice bulletin no. 137: gestational diabetes mellitus. Obstet Gynecol 122:406–416

    Article  Google Scholar 

  18. Robinson CA, Agarwal G, Nerenberg K (2011) Validating the CANRISK prognostic model for assessing diabetes risk in Canada’s multi-ethnic population. Chronic Dis Inj Can 32:19–31

    CAS  PubMed  Google Scholar 

  19. Sheffield JS, Butler-Koster EL, Casey BM, McIntire DD, Leveno KJ (2002) Maternal diabetes mellitus and infant malformations. Obstet Gynecol 100:925–930

    PubMed  Google Scholar 

  20. Moyer VA, Force USPST (2014) Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 160:414–420

    PubMed  Google Scholar 

  21. American Diabetes A (2015) Management of diabetes in pregnancy. Diabetes Care 38(Suppl):S77–S79

    Article  Google Scholar 

  22. Ozcimen EE, Uckuyu A, Ciftci FC, Yanik FF, Bakar C (2008) Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment-insulin resistance index in the first trimester. Gynecol Endocrinol 24:224–229

    Article  CAS  PubMed  Google Scholar 

  23. Gibson KS, Waters TP, Catalano PM (2012) Maternal weight gain in women who develop gestational diabetes mellitus. Obstet Gynecol 119:560–565

    Article  PubMed  Google Scholar 

  24. Carreno CA, Clifton RG, Hauth JC, Myatt L, Roberts JM, Spong CY et al (2012) Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women. Obstet Gynecol 119:1227–1233

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hedderson MM, Williams MA, Holt VL, Weiss NS, Ferrara A (2008) Body mass index and weight gain prior to pregnancy and risk of gestational diabetes mellitus. Am J Obstet Gynecol 198(409):e401–e407

    Google Scholar 

  26. Moller DE, Flier JS (1991) Insulin resistance—mechanisms, syndromes, and implications. N Engl J Med 325:938–948

    Article  CAS  PubMed  Google Scholar 

  27. Mantzoros CS, Flier JS (1995) Insulin resistance: the clinical spectrum. Adv Endocrinol Metab 6:193–232

    CAS  PubMed  Google Scholar 

  28. Catalano PM, Tyzbir ED, Roman NM, Amini SB, Sims EA (1991) Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol 165:1667–1672

    Article  CAS  PubMed  Google Scholar 

  29. Buchanan TA, Watanabe RM, Xiang AH (2010) Limitations in surrogate measures of insulin resistance. J Clin Endocrinol Metab 95:4874–4876

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Tritos NA, Mantzoros CS (1998) Clinical review 97: syndromes of severe insulin resistance. J Clin Endocrinol Metab 83:3025–3030

    Article  CAS  PubMed  Google Scholar 

  31. Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R (2003) Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care 26:3320–3325

    Article  CAS  PubMed  Google Scholar 

  32. Grewal E, Kansara S, Kachhawa G, Ammini AC, Kriplani A, Aggarwal N et al (2012) Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects. Metabolism 61:715–720

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank Aysel Kıyıcı, Müfide Öncel, Emel Şahin, and staff of the Mevlana University Biochemistry Laboratory for assistance.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Mevlana University Faculty of Medicine, Konya, Turkey

    Hüsnü Alptekin, Hatice Işık & Türkan Cengiz

  2. Department of Internal Medicine, Mevlana University Faculty of Medicine, Konya, Turkey

    Ahmet Çizmecioğlu & Murat Yildiz

  3. Department of Medical Education and Informatics, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

    Mehmet Sinan Iyisoy

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  1. Hüsnü Alptekin
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  2. Ahmet Çizmecioğlu
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Correspondence to Hüsnü Alptekin.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards, and the study was approved by the local ethics committee at Karolinska Institutet.

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Informed consent was obtained from all individual participants included in the study.

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Alptekin, H., Çizmecioğlu, A., Işık, H. et al. Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR. J Endocrinol Invest 39, 577–583 (2016). https://doi.org/10.1007/s40618-015-0427-z

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  • DOI: https://doi.org/10.1007/s40618-015-0427-z

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