Skip to main content
SMFM 2024 Pregnancy Meeting Main banner
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared on social media
Faculty have requested this content not be shared on social media
CME Credit Offered
CME Credit Offered
Poster Icons
Foundation Awardee
Foundation Awardee
No Social Media
No Social Media
Back
Q&A

Diabetes

Poster Session 2

(564) Association between insulin resistance and pregnancy outcomes in obese pregnant individuals

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Foundation Awardee
Objective:

In gestational diabetes (GDM), predominance of insulin resistance is associated with an increased risk of adverse pregnancy outcomes. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) is a validated tool to estimate insulin resistance. Our objective was to determine if insulin resistance in early pregnancy, estimated by HOMA-IR, is associated with adverse pregnancy outcomes in obese pregnant individuals.

Study Design:

From September 2014 to September 2019, obese pregnant individuals, defined as body mass index (BMI) ≥ 30 kg/m2, were enrolled in a prospective cohort study. Plasma samples were collected between 14-20 weeks gestation and fasting insulin and glucose levels were measured. Insulin resistance was estimated using HOMA-IR. We assessed the association between HOMA-IR and adverse pregnancy outcomes. Participants were grouped based on low (HOMA-IR ≤ 3.8) or high (HOMA-IR > 3.8) insulin resistance. We performed univariate analyses as well as adjusted analyses controlling for pre-pregnancy BMI, smoking and parity.

Results:

We analyzed data of 238 participants with a mean HOMA-IR of 4.2 ± 4.9 (IQR 2.2-4.4). High insulin resistance occurred in n=77 (32.4%) of the cohort. Demographics and pregnancy outcomes by HOMA-IR level are presented in the table. Individuals with high HOMA-IR had a higher pre-pregnancy BMI (42.6 ± 7.9 vs 38.5 ± 5.5, p < 0.0001) and a higher rate of GDM (16.9% vs 4.3%, p < 0.0001) and hypertensive disorders of pregnancy (16.9% vs 11.2%, p < 0.0001). Only the rate of GDM remained statistically significant in adjusted analyses (p=0.001). There was no difference in the rate of large for gestational age (LGA), birthweight, and birthweight percentile between individuals with high and low HOMA-IR. In sex-specific analyses, high HOMA-IR was associated with lower birthweight in female infants (p=0.04). This finding was no longer significant after controlling for pre-pregnancy BMI, smoking and GDM (p=0.08).

Conclusion:

High insulin resistance is associated with a higher risk of GDM in obese pregnant individuals, but it was not related to birthweight or rate of LGA.