Association of maternal insulin resistance with neonatal insulin resistance and body composition/size: a prospective cohort study in a sub-Saharan African population.

PURPOSE: We prospectively evaluated the association of the insulin resistance of third-trimester Nigerian pregnant women with their newborn infants' insulin resistance and birth size. Pregnancy-associated insulin resistance (IR), often assessed with homeostatic model assessment of IR (HOMA-IR), is associated, especially among women with gestational diabetes (GDM), with abnormal neonatal birth size and body composition, predisposing the baby to metabolic disorders like diabetes and obesity. The associations of maternal IR with neonatal IR, birth size and body composition are less studied in nondiabetic pregnant women, especially in sub-Saharan settings like Nigeria. METHODS: We originally recruited 401 third trimester, nondiabetic pregnant women to a prospective cohort study, followed up until birth. Blood samples of mothers and babies were obtained, respectively, at recruitment and within 24 hours postbirth for fasting serum glucose (FSG) and insulin (FSI) assays, and HOMA-IR was calculated as [(FSI × FSG)/22.5)]. RESULTS: Complete data for 150 mother-baby dyads was analysed: the mothers, with a mean (standard deviation [SD]) age of 31.6 (4.5) years, had live births at a mean (SD) gestational age of 39.2 weeks. The proportions of infants with wasting, stunting, impaired fetal growth (either wasting or stunted), small-for-gestation-age, large-for-gestational-age, low birthweight, and macrosomia were 4.2% (95% confidence interval, 1.1-10.3), 19.7% (12.9-28.0), 23.1% (15.8-31.8), 10.1% (5.3-17.0), 12.6% (7.2-19.9), 0.8% (0.02-4.5), and 5.0% (1.8-10.5), respectively. Maternal HOMA-IR was not associated with neonatal HOMA-IR (p=0.837), birth weight (p=0.416) or body composition measured with weight-length ratio (p=0.524), but birth weight was independently predicted by maternal weight (p=0.006), body mass index (p=0.001), and parity (p=0.012). CONCLUSION: In this nondiabetic/non-GDM cohort, maternal HOMA-IR was not associated with neonatal IR, body size or body composition. Larger studies are required to confirm these findings, with addi-tional inclusion of mothers with hyperglycaemia for comparison.

Prevalence of insulin resistance among patients attending the HIV clinic in a Nigerian tertiary hospital.

BACKGROUND: Insulin Resistance(IR) is increasing in Africans as well as among the Human Immunodeficiency Virus(HIV) infected population for several reasons which include the viral infection itself and the use of Highly active antiretroviral therapy (HAART). This present study assessed the prevalence of IR among HIV infected population and the imminent effect of the disease and therapy on patients. METHODS: This cross sectional study was conducted in Lagos among 266 HIV infected participants and 130 HIV Negative controls aged 18-80 years. Questionnaires were administered and fasting venous blood samples collected for plasma glucose and insulin. Homeostatic Model Assessment (HOMA-IR) and Quantitative Insulin Check Index (QUICKI) indices were used to establish Insulin Resistance using a cut off of >2 and <0.339 respectively. RESULTS: Insulin resistance was prevalent in 24.1% of HIV-infected participants based on a HOMA-IR and 21.1% using QUICKI compared to 8.5% and 4.6% in the HIV uninfected controls (p<0.001). A prevalence of 25.8% was found among the HAART exposed group compared to 10% among the HAART naïve group (p=0.056) using HOMA-IR while QUICKI results showed 22.5% and 10% respectively (p=0.115). CONCLUSION: This study established a significantly high prevalence of IR among HIV infected patients and a higher but non-significant prevalence among the HAART exposed group. Close monitoring of patients is recommended to reduce the risk of developing Diabetes Mellitus. Further research work is needed to identify ways of lowering the prevalence of IR in HIV infected persons.

An audit of chemical pathology laboratory investigation request forms received at a private tertiary hospital in Nigeria

Context: Laboratory testing constitutes an integral part of patient management and has an extensive influence on medical decision-making. The completion of laboratory investigation request forms is a vital aspect of the highly variable pre-analytical phase of laboratory testing.Aim: We aimed to assess the adequacy of completion of investigation request forms received at our laboratory.Methods: An audit of systematically selected laboratory investigation request forms received over a six-month period at our laboratory was performed to assess the degree of completion of these forms by requesting clinicians. Data was analysed using Microsoft Excel®.Results: Two hundred and fifty four request forms were reviewed. None of the reviewed forms was adequately completed. The clinician's contact number was missing in all the request forms. About two-thirds of the request forms did not have the patient's hospital number (66.1%) and the referring clinician's signature (66.9%) available on them. The clinical diagnosis of the patient was not stated in 18.9% of the request forms. The patient's name, gender and age were the most frequently completed parameters in 100.0%, 98.4% and 97.2% of the request forms respectively.Conclusion: Basic information required for the accurate interpretation of laboratory results are missing in several request forms. This may have deleterious impact on laboratory turn around time, healthcare costs and patient management as most medical decisions are influenced by laboratory results