High prevalence of early (1st trimester) gestational diabetes mellitus in Polish women is accompanied by marked insulin resistance — comparison to PCOS model
, 3, 45, 6, 45, 12
Abstract
Introduction: Both pregnancy and polycystic ovary syndrome (PCOS) constitute insulin-resistant states that are associated with an increased prevalence of glucose intolerance. Some women demonstrate significant insulin resistance (IR) and develop gestational diabetes (GDM) even in the 1st trimester. We compared surrogate IR indices in 1st-trimester pregnant women and in women with PCOS (Rotterdam consensus criteria).
Material and methods: We performed a 75-g oral glucose tolerance test (OGTT) with insulin measurements in 106 healthy 1st-trimester pregnant women at 9.9 ± 2.6 weeks of gestation and in 418 women with PCOS. We assessed IR (HOMA-IR, QUICKI, Matsuda, Belfiore, and Stumvoll indices) as well as the prevalence of GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADSPG) and World Health Organization (WHO) (1999) criteria.
Results: Despite having a slightly lower BMI (p = 0.027), pregnant women had either similar (QUICKI, Belfiore index, Stumvoll0–120 min) or greater IR than women with PCOS (e.g. HOMA-IR 3.85 ± 6.11 vs. 2.64 ± 2.04, p = 0.002), while only the Matsuda index demonstrated less IR in pregnant women (p = 0.003). The correlation between IR indices in pregnant women showed marked variability, ranging from r = 0.334 (HOMA-IR vs. Belfiore index) to r = –1.0 (HOMA-IR vs. QUICKI, p < 0.001). This was accompanied by a high prevalence of GDM (14.2% and 9.4%, IADPSG and WHO criteria, respectively). Women with GDM diagnosed according to IADPSG criteria demonstrated greater IR than pregnant women without GDM. In women with GDM diagnosed according to WHO (1999) criteria these differences were
visible only for OGTT-derived IR indices (Belfiore, Matsuda, and Stumvoll0–120 index).
Conclusions: Depending on the choice of IR indices, healthy 1st-trimester pregnant women demonstrate either similar or greater IR than women with PCOS, and this is accompanied by a high prevalence of early GDM. It remains to be established whether GDM screening should be performed in the 1st trimester.
Keywords: gestational diabetes mellitusGDMinsulin resistancepregnancyPCOSpolycystic ovary syndromeHOMA-IRQUICKIBelfiore indexMatsuda indexStumvoll index
References
- Li-Zhen L, Yun Xu, Xiao-Dong Z, et al. Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review. BMJ Open. 2019; 9(5): e023014.
- Virally M, Laloi-Michelin M. Methods for the screening and diagnosis of gestational diabetes mellitus between 24 and 28 weeks of pregnancy. Diabetes Metab. 2010; 36(6 Pt 2): 549–565.
- Benhalima K, Minschart C, Van Crombrugge P, et al. The 2019 Flemish consensus on screening for overt diabetes in early pregnancy and screening for gestational diabetes mellitus. Acta Clin Belg. 2020; 75(5): 340–347.
- Li MY, Rawal S, Hinkle SN, et al. Sex Hormone-binding Globulin, Cardiometabolic Biomarkers, and Gestational Diabetes: A Longitudinal Study and Meta-analysis. Matern Fetal Med. 2020; 2(1): 2–9.
- Guan Y, Wang D, Bu H, et al. The Effect of Metformin on Polycystic Ovary Syndrome in Overweight Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol. 2020; 2020: 5150684.
- Ehrmann DA, Barnes RB, Rosenfield RL, et al. Prevalence of impaired glucose tolerance and diabetes in women with polycystic ovary syndrome. Diabetes Care. 1999; 22(1): 141–146.
- Goodman NF, Cobin RH, Futterweit W, et al. American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), Androgen Excess and PCOS Society. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ANDROGEN EXCESS AND PCOS SOCIETY DISEASE STATE CLINICAL REVIEW: GUIDE TO THE BEST PRACTICES IN THE EVALUATION AND TREATMENT OF POLYCYSTIC OVARY SYNDROME - PART 2. Endocr Pract. 2015; 21(12): 1415–1426.
- Kampmann U, Knorr S, Fuglsang J, et al. Determinants of Maternal Insulin Resistance during Pregnancy: An Updated Overview. J Diabetes Res. 2019; 2019: 5320156.
- DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979; 237(3): E214–E223.
- Weinert LS, Metzger BE, Gabbe SG, et al. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33(3): 676–682.
- Alberti K, Zimmet P. Definition, diagnosis and classification of diabetes mellitus. Part 1: diagnosis and classification of diabetes mellitus: World Health Organization Report. Diabet Med. 1998; 15(7): 539–553.
- World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus. World Health Organization (1999). https://apps.who.int/iris/handle/10665/66040.
- Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod. 2004; 19(1): 41–47.
- Belfiore F, Iannello S, Volpicelli G. Insulin sensitivity indices calculated from basal and OGTT-induced insulin, glucose, and FFA levels. Mol Genet Metab. 1998; 63(2): 134–141.
- Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7): 412–419.
- Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000; 85(7): 2402–2410.
- Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999; 22(9): 1462–1470.
- Stumvoll M, Mitrakou A, Pimenta W, et al. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care. 2000; 23(3): 295–301.
- Mills JL, Jovanovic L, Knopp R, et al. Physiological reduction in fasting plasma glucose concentration in the first trimester of normal pregnancy: the diabetes in early pregnancy study. Metabolism. 1998; 47(9): 1140–1144.
- Grewal E, Kansara S, Kachhawa G, et al. Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects. Metabolism. 2012; 61(5): 715–720.
- Seshiah V, Balaji V, Balaji MS, et al. Gestational diabetes mellitus manifests in all trimesters of pregnancy. Diabetes Res Clin Pract. 2007; 77(3): 482–484.
- Yachi Y, Tanaka Y, Anasako Y, et al. Contribution of first trimester fasting plasma insulin levels to the incidence of glucose intolerance in later pregnancy: Tanaka women's clinic study. Diabetes Res Clin Pract. 2011; 92(2): 293–298.
- Ozcimen EE, Uckuyu A, Ciftci FC, et al. Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment-insulin resistance index in the first trimester. Gynecol Endocrinol. 2008; 24(4): 224–229.
- Ozgu-Erdinc AS, Yilmaz S, Yeral MI, et al. Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices. J Matern Fetal Neonatal Med. 2015; 28(16): 1957–1962.
- Hoffman RP. Indices of insulin action calculated from fasting glucose and insulin reflect hepatic, not peripheral, insulin sensitivity in African-American and Caucasian adolescents. Pediatr Diabetes. 2008; 9(3 Pt 2): 57–61.
- Singh B, Saxena A. Surrogate markers of insulin resistance: A review. World J Diabetes. 2010; 1(2): 36–47.
- Shulman GI, Rothman DL, Jue T, et al. Quantitation of muscle glycogen synthesis in normal subjects and subjects with non-insulin-dependent diabetes by 13C nuclear magnetic resonance spectroscopy. N Engl J Med. 1990; 322(4): 223–228.
- Lewandowski KC, Płusajska J, Horzelski W, et al. Limitations of insulin resistance assessment in polycystic ovary syndrome. Endocr Connect. 2018; 7(3): 403–412.
- Vrbíková J, Hill M, Dvoráková K, et al. Prevalence of insulin resistance and prediction of glucose intolerance and type 2 diabetes mellitus in women with polycystic ovary syndrome. Clin Chem Lab Med. 2007; 45(5): 639–644.
- Catalano PM, Tyzbir ED, Roman NM, et al. Longitudinal changes in insulin release and insulin resistance in nonobese pregnant women. Am J Obstet Gynecol. 1991; 165(6 Pt 1): 1667–1672.
- Lesser KB, Carpenter MW. Metabolic changes associated with normal pregnancy and pregnancy complicated by diabetes mellitus. Semin Perinatol. 1994; 18(5): 399–406.
- Corrado F, D'Anna R, Cannata ML, et al. Correspondence between first-trimester fasting glycaemia, and oral glucose tolerance test in gestational diabetes diagnosis. Diabetes Metab. 2012; 38(5): 458–461.
- Zhu WW, Yang HX, Wei YM, et al. Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in china. Diabetes Care. 2013; 36(3): 586–590.
- McIntyre HD, Sacks DA, Barbour LA, et al. Issues With the Diagnosis and Classification of Hyperglycemia in Early Pregnancy. Diabetes Care. 2016; 39(1): 53–54.
- Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Gestational diabetes mellitus diagnosed during early pregnancy. Am J Obstet Gynecol. 2000; 182(2): 346–350.
- Easmin S, Chowdhury TA, Islam MR, et al. Obstetric Outcome in Early and Late Onset Gestational Diabetes Mellitus. Mymensingh Med J. 2015; 24(3): 450–456.
- Seshiah V, Cynthia A, Balaji V, et al. Detection and care of women with gestational diabetes mellitus from early weeks of pregnancy results in birth weight of newborn babies appropriate for gestational age. Diabetes Res Clin Pract. 2008; 80(2): 199–202.
- Immanuel J, Simmons D. Screening and Treatment for Early-Onset Gestational Diabetes Mellitus: a Systematic Review and Meta-analysis. Curr Diab Rep. 2017; 17(11): 115.
- Hod M, Kapur A, Sacks DA, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet. 2015; 131 Suppl 3: S173–S211.
- Liu B, Cai J, Xu Y, et al. Early Diagnosed Gestational Diabetes Mellitus Is Associated With Adverse Pregnancy Outcomes: A Prospective Cohort Study. J Clin Endocrinol Metab. 2020; 105(12).
- Hong WY, Biggio JR, Tita A, et al. Impact of Early Screening for Gestational Diabetes on Perinatal Outcomes in High-Risk Women. Am J Perinatol. 2016; 33(8): 758–764.
- Nakanishi S, Aoki S, Kasai J, et al. High probability of false-positive gestational diabetes mellitus diagnosis during early pregnancy. BMJ Open Diabetes Res Care. 2020; 8(1).
- Gardner B, Croker H, Barr S, et al. UPBEAT Trial. Psychological predictors of dietary intentions in pregnancy. J Hum Nutr Diet. 2012; 25(4): 345–353.
