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Published on: January 7, 2018
Postpartum assessment of insulin resistance indicators in mothers with gestational diabetes: A prospective
Karolina Karcz1, Paulina Gaweł1, Barbara Królak-Olejnik1
1Department of Neonatology, Wroclaw Medical University, Poland.
Background:
Gestational diabetes mellitus (GDM) is characterized by a higher degree of insulin resistance (IR) than in a normal pregnancy. Several surrogate measures have been proposed to assess insulin sensitivity, including glycated hemoglobin, the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR), and the Quantitative Insulin Sensitivity Check Index (QUICKI).
Objectives:
The aim of the study was to determine whether markers of IR in the 1st week postpartum differ between mothers with GDM and healthy controls, and whether mothers with GDM treated with insulin have significantly different levels of IR markers compared with those treated with diet and physical activity. The association between IR markers, pregnancy outcomes, and maternal glucose profiles based on the oral glucose tolerance test (OGTT) was also investigated.
Material And Methods:
Among the 70 participants, 50 mothers were diagnosed with GDM; 21 were treated with diet and physical activity (GDM G1), while 29 received insulin therapy (GDM G2). The remaining 20 participants constituted a control group with no history of glucose intolerance before or during pregnancy (non-GDM). A range of statistical methods (e.g., analysis of variance (ANOVA), Kruskal-Wallis test, χ2 test, regression analysis, and cluster analysis) were used to compare data between study groups, with a significance level of α = 0.05.
Results:
The results showed that selected markers of IR in the 1st week after delivery differed significantly between mothers. Mothers with GDM exhibited considerably higher levels of HOMA-IR and HbA1c (p < 0.05), yet no substantially divergent QUICKI (p > 0.05) in the 1st week postpartum. Additionally, they demonstrated elevated glucose levels at 3 OGTT time points in comparison with non-GDM mothers. The GDM G2 group exhibited higher values than the GDM G1 group, except for the 1 h OGTT. Identification of maternal glucose phenotypes confirmed variability in the degree of glucose metabolism disorders among mothers.
Conclusions:
Cluster analysis and glucose phenotype stratification in mothers with GDM help identify high-risk groups and support targeted counseling and monitoring to improve pregnancy outcomes.
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