Insulin resistance and pregnancy outcomes in gestational diabetes mellitus gravida complicated by chronic hypertension / 中华围产医学杂志

ABSTRACT

Objective To analyze insulin resistance (IR) level and pregnancy outcomes in women with gestational diabetes mellitus (GDM) complicated by chronic hypertension (CHT).Methods This is a retrospective case-control study involving 2 457 singleton pregnant women complicated by GDM who received regular prenatal examinations and participated in the one-day-care clinic of GDM in Peking University First Hospital from January 1,2014 to December 31,2016.Clinical data were collected and homeostasis model assessment insulin resistance (HOMA-IR) was calculated.All subjects were divided into two groupsGDM with CHT group (CHT group,n=47) and GDM without CHT group (non-CHT group,n=2 410).Based on their pre-pregnancy body mass index (BMI),they were also grouped into normal pre-pregnancy BMI group (n=1 590) and overweight and obese group (n=863).Two-sample independent t test and Chi-square test were used to compared the age,HOMA-IR,pre-pregnancy BMI,weight gain during pregnancy and glucose levels between groups,and logistic regression model was used to analyze the effects of HOMA-IR on pregnancy outcomes.Results HOMA-IR (3.5± 1.8 vs 2.6± 1.5,t=-3.290),fasting plasma glucose [(5.4±0.5) vs (5.2 ±0.5) mmol/L,t=-3.005],pre-pregnancy BMI [(26.7 ±4.7) vs (23.3± 3.4) kg/m2,t=-4.842] and the incidence of preeclampsia [14.9％ (7/47) vs 2.5％ (61/2 410),x2=21.790] were significantly higher in GDM women with CHT than those without (all P＜0.01).The weight gain during pregnancy was less[(9.6±5.8) vs (12.2±4.7) kg,t=3.790,P＜0.001].The incidence of preeclampsia was higher in GDM with CHT group than the non-CHT group [15.2％ (5/33) vs 4.2％ (35/830),x2=6.290,P=0.012] among overweight and obese pregnant women,but no significant difference in HOMA-IR was shown (P＞0.05).For pregnant women with normal pre-pregnancy BMI,HOMA-IR (3.0± 1.5 vs 2.3± 1.2,t=-2.217),fasting plasma glucose [(5.4±0.5) vs (5.1±0.5) mmol/L,t=-2.299] and the incidence of preeclampsia [2/14 vs 1.6％ (26/1 576),x2=6.545] were higher in the CHT group than the non-CHT group (all P＜0.05).HOMA-IR did not significantly increase the risk of caesarean section,premature birth,large for gestational age,small for gestational age or macrosomia in the CHT group (all P＞0.05).After adjusting for age,fasting plasma glucose,pre-pregnancy BMI and weight gain during pregnancy,the elevated HOMA-IR level increased the risk of preterm birth (OR=1.223,95％CI1.093-1.369,P＜0.001) in GDM women without CHT.Conclusions GDM gravida complicated by CHT have severe insulin resistance and a higher incidence of preeclampsia,but the risk of other pregnancy outcomes are not increased.