Insulin response patterns contribute to different perinatal risks in gestational diabetes.

Area of Science:

• Endocrinology
• Obstetrics
• Metabolic Disorders

Background:

• Gestational diabetes mellitus (GDM) affects pregnancy, with implications for maternal and infant health.
• Insulin dynamics in GDM patients are not fully understood, contributing to varied clinical presentations.
• Understanding insulin response patterns is crucial for predicting perinatal outcomes in GDM.

Purpose of the Study:

• To evaluate insulin dynamics in patients with GDM.
• To compare perinatal outcomes based on distinct insulin response patterns in GDM.
• To investigate the heterogeneity of GDM through subgroup analysis.

Main Methods:

• A 2-hour 75-gram oral glucose tolerance test (OGTT) was used to assess plasma glucose and insulin responses.
• Insulinogenic index (II) and area under the curve (AUC) for glucose (AUCg) and insulin (AUCi) were measured.
• GDM patients were categorized into hyper-, normo-, and hypoinsulinemic subgroups based on AUCi compared to controls.

Main Results:

• GDM patients exhibited impaired insulin secretion and reduced insulin/glucose ratios during OGTT.
• Reduced insulin responses were noted in hypo- and normoinsulinemic GDM, but not in hyperinsulinemic GDM.
• Normo- and hypoinsulinemic GDM were associated with a higher incidence of large-for-gestational-age infants, while hyperinsulinemic GDM showed increased pregnancy-induced hypertension and higher pre-pregnancy BMI.

Conclusions:

• GDM is a heterogeneous condition with distinct insulin secretion patterns.
• Insulin response patterns in GDM significantly influence perinatal outcomes, including infant size and maternal complications.
• Subgroup analysis of GDM reveals differing clinical and metabolic characteristics, necessitating tailored management approaches.