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Epidemiology

Poster Session 2

(472) Association between adverse pregnancy outcomes and insulin resistance 2-7 years later

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To evaluate associations between non-GDM adverse pregnancy outcomes (APOs) and insulin resistance in the years following delivery.

Study Design: Secondary analysis of a prospective cohort of nulliparous participants enrolled during the first trimester and followed 2-7 years postpartum. We included all participants who completed a study visit at 2-7 years postpartum and excluded those with diabetes (pre-gestational or GDM) in the index pregnancy, a subsequent pregnancy during the study period, or who were not fasting at the study visit. The exposure was APO (hypertensive disorder of pregnancy, SGA, PTB, stillbirth) in the index pregnancy. The primary outcome was insulin resistance (continuous variable) measured via fasting homeostasis model assessment of insulin resistance (HOMA-IR) at follow-up. HOMA-IR is a pre-clinical measure of insulin resistance calculated from fasting insulin and glucose. Secondary categorical outcomes were highest tertile of HOMA-IR, prediabetes, and incident diabetes. Multivariable logistic regression estimated associations between APOs and outcomes of interest, adjusting for confounders.

Results: Among 4,484 study participants, 3,047 were eligible for this analysis; 763 (25%) experienced APOs in index pregnancy. History of APO was associated with higher HOMA-IR at mean 2.7±0.9 years follow-up [adjusted Geometric Mean (95% CI): 1.4 (1.3, 1.5) vs 1.3 (1.3, 1.4), p = 0.01]. History of APO was also associated with HOMA-IR in the highest tertile and prediabetes (Table). The association between APOs and incident diabetes was not significant. Results were robust to adjustment.

Conclusion: In primiparas without GDM, APO history was associated with higher insulin resistance 2-7 years after first pregnancy.