Sanmaan K Basraon1, Lisa Mele2, Leslie Myatt3, James M Roberts4, John C Hauth5, Kenneth J Leveno6, Michael W Varner7, Ronald J Wapner8, John M Thorp9, Alan M Peaceman10, Susan M Ramin11, Anthony Sciscione12, Jorge E Tolosa13, Yoram Sorokin14. 1. Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas. 2. Biostatistics Center, George Washington University, Washington, District of Columbia. 3. University of Cincinnati, Cincinnati, Ohio. 4. University of Pittsburgh, Pittsburgh, Pennsylvania. 5. University of Alabama at Birmingham, Birmingham, Alabama. 6. University of Texas Southwestern Medical Center, Dallas, Texas. 7. University of Utah Health Sciences Center, Salt Lake City, Utah. 8. Columbia University, New York, New York. 9. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 10. Northwestern University, Chicago, Illinois. 11. University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas. 12. Drexel University, Philadelphia, Pennsylvania. 13. Oregon Health & Science University, Portland, Oregon. 14. Wayne State University, Detroit, Michigan.
Abstract
OBJECTIVE: To determine the risk of gestational diabetes mellitus (GDM) and insulin resistance (IR) in obesity defined by body mass index (BMI), waist-to-hip ratio (WHR), or both combined. METHODS: Secondary analysis of a randomized multicenter trial of antioxidant supplementation versus placebo in nulliparous low-risk women to prevent pregnancy associated hypertension. Women between 9 and 16 weeks with data for WHR and BMI were analyzed for GDM (n = 2,300). Those with fasting glucose and insulin between 22 and 26 weeks (n = 717) were analyzed for IR by homeostatic model assessment of IR (normal, ≤ 75th percentile). WHR and BMI were categorized as normal (WHR, < 0.80; BMI, < 25 kg/m(2)); overweight (WHR, 0.8-0.84; BMI, 25-29.9 kg/m(2)); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m(2)). Receiver operating characteristic curves and logistic regression models were used. RESULTS: Compared with normal, the risks of GDM or IR were higher in obese by BMI or WHR. The subgroup with obesity by WHR but not by BMI had no increased risk of GDM. BMI was a better predictor of IR (area under the curve [AUC]: 0.71 [BMI], 0.65 [WHR], p = 0.03) but similar to WHR for GDM (AUC: 0.68 [BMI], 0.63 [WHR], p = 0.18). CONCLUSION:Increased WHR and BMI in early pregnancy are associated with IR and GDM. BMI is a better predictor of IR compared with WHR. Adding WHR to BMI does not improve its ability to detect GDM or IR. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
RCT Entities:
OBJECTIVE: To determine the risk of gestational diabetes mellitus (GDM) and insulin resistance (IR) in obesity defined by body mass index (BMI), waist-to-hip ratio (WHR), or both combined. METHODS: Secondary analysis of a randomized multicenter trial of antioxidant supplementation versus placebo in nulliparous low-risk women to prevent pregnancy associated hypertension. Women between 9 and 16 weeks with data for WHR and BMI were analyzed for GDM (n = 2,300). Those with fasting glucose and insulin between 22 and 26 weeks (n = 717) were analyzed for IR by homeostatic model assessment of IR (normal, ≤ 75th percentile). WHR and BMI were categorized as normal (WHR, < 0.80; BMI, < 25 kg/m(2)); overweight (WHR, 0.8-0.84; BMI, 25-29.9 kg/m(2)); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m(2)). Receiver operating characteristic curves and logistic regression models were used. RESULTS: Compared with normal, the risks of GDM or IR were higher in obese by BMI or WHR. The subgroup with obesity by WHR but not by BMI had no increased risk of GDM. BMI was a better predictor of IR (area under the curve [AUC]: 0.71 [BMI], 0.65 [WHR], p = 0.03) but similar to WHR for GDM (AUC: 0.68 [BMI], 0.63 [WHR], p = 0.18). CONCLUSION: Increased WHR and BMI in early pregnancy are associated with IR and GDM. BMI is a better predictor of IR compared with WHR. Adding WHR to BMI does not improve its ability to detect GDM or IR. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Authors: John C Hauth; Rebecca G Clifton; James M Roberts; Leslie Myatt; Catherine Y Spong; Kenneth J Leveno; Michael W Varner; Ronald J Wapner; John M Thorp; Brian M Mercer; Alan M Peaceman; Susan M Ramin; Marshall W Carpenter; Philip Samuels; Anthony Sciscione; Jorge E Tolosa; George Saade; Yoram Sorokin; Garland D Anderson Journal: Am J Obstet Gynecol Date: 2011-04 Impact factor: 8.661
Authors: A Pascot; J P Després; I Lemieux; N Alméras; J Bergeron; A Nadeau; D Prud'homme; A Tremblay; S Lemieux Journal: Diabetes Care Date: 2001-05 Impact factor: 19.112
Authors: Andrea Cardoso Pontual; José Natal Figueiroa; Leanne R De Souza; Joel G Ray; João Guilherme Bezerra Alves Journal: Matern Child Health J Date: 2016-08