- Email: [email protected]
527: Fetal gender and maternal insulin resistance during mid-pregnancy
Poster Session III
ajog.org STUDY DESIGN: Retrospective study of women with DM and GDMA2 admitted for delivery between 10/2011 and 7/2016 at Thomas Jefferson Hospital. All women had glycemic evaluation and insulin drip as needed during labor. Optimal glycemic control was defined as capillary blood glucose (CBG) 60-100mg/dL. Women with scheduled cesarean section were excluded. Primary outcome was incidence of neonatal hypoglycemia defined as at least one CBG <40mg/dL. Secondary outcomes were mean intrapartum maternal CBG levels, intrapartum insulin requirements, mode of delivery, and NICU admission secondary to neonatal hypoglycemia. Results were stratified by DM and GDMA2 diagnosis. RESULTS: 72 with DM and 80 women with GDMA2 were admitted for delivery. There were no significant differences in maternal demographics between DM vs GDMA2 (Table). Optimal glycemic control (CBG 60-100mg/dL) vs any elevated value >100mg/dL during the last 6 and 12 hours before delivery decreased the risk of neonatal hypoglycemia from 31% to 14% (OR 0.36; 95% CI 0.150.88) and from 32% to 15% (OR 0.38; 95% CI 0.16-0.88) respectively, (Figure). Women with DM had higher levels of intrapartum CBG, required more intrapartum insulin, had higher incidence of neonatal hypoglycemia and cesarean section when compared to GDMA2. CONCLUSION: Neonatal hypoglycemia was directly associated with intrapartum CBG levels. Optimal control of intrapartum CBG (60-100mg/dL) during the last 6 hours of labor was associated with a 64% reduction in the neonatal hypoglycemia incidence.
527 Fetal gender and maternal insulin resistance during mid-pregnancy Ichiro Yasuhi, Hiroshi Yamashita, Sachie Suga, Misao Fukuoka, Megumi Koga, So Sugimi, Yasushi Umezaki, Masashi Fukuda, Nobuko Kusuda NHO Nagasaki Medical Center, Omura-City, Japan
OBJECTIVE: Recent studies have suggested that fetal sex influences maternal insulin dynamics during pregnancy. We examined whether the difference in fetal sex is associated with maternal insulin resistance and b-cell function during pregnancy. STUDY DESIGN: We included singleton women who underwent the 75gOGTT between 24 and 34 weeks’ gestation due to a positive diabetic screen. In addition to plasma glucose (PG), we measured plasma insulin during the OGTT to obtain surrogate indices associated with insulin resistance (IR), including homeostasis assessment model (HOMA)-IR and insulin sensitivity index (IsOGTT), and b-cell function, including insulinogenic index (II) and HOMA-b. We compared those indices between women bearing male vs. female fetuses. RESULTS: We included 617 women aged 32.44.9 years with a mean prepregnancy body mass index (BMI) of 22.64.5. They underwent the 75g-OGTT at 29.02.5 weeks, and 258 (42%) women were diagnosed with gestational diabetes (GDM). There was no significant difference in maternal age, prepregnancy BMI, gestational age at OGTT, PG at OGTT, or the prevalence of GDM between women with a male fetus (n¼338) (male group) and female fetus (n¼279) (female group). Regarding the indices of IR, IR was significantly higher and insulin sensitivity was lower in the female fetus group than in the male fetus group (Table). Those differences remained significant after adjusting for maternal age, prepregnancy BMI, gestational age and fasting PG at OGTT, and GDM diagnosis. In contrast, the b-cell function did not differ markedly between the groups. CONCLUSION: Maternal IR was significantly higher in women bearing a female fetus than in those bearing a male fetus after adjusting for confounders. The gender of the fetus may affect maternal insulin sensitivity during mid-pregnancy.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S311
ajog.org STUDY DESIGN: Retrospective study of women with DM and GDMA2 admitted for delivery between 10/2011 and 7/2016 at Thomas Jefferson Hospital. All women had glycemic evaluation and insulin drip as needed during labor. Optimal glycemic control was defined as capillary blood glucose (CBG) 60-100mg/dL. Women with scheduled cesarean section were excluded. Primary outcome was incidence of neonatal hypoglycemia defined as at least one CBG <40mg/dL. Secondary outcomes were mean intrapartum maternal CBG levels, intrapartum insulin requirements, mode of delivery, and NICU admission secondary to neonatal hypoglycemia. Results were stratified by DM and GDMA2 diagnosis. RESULTS: 72 with DM and 80 women with GDMA2 were admitted for delivery. There were no significant differences in maternal demographics between DM vs GDMA2 (Table). Optimal glycemic control (CBG 60-100mg/dL) vs any elevated value >100mg/dL during the last 6 and 12 hours before delivery decreased the risk of neonatal hypoglycemia from 31% to 14% (OR 0.36; 95% CI 0.150.88) and from 32% to 15% (OR 0.38; 95% CI 0.16-0.88) respectively, (Figure). Women with DM had higher levels of intrapartum CBG, required more intrapartum insulin, had higher incidence of neonatal hypoglycemia and cesarean section when compared to GDMA2. CONCLUSION: Neonatal hypoglycemia was directly associated with intrapartum CBG levels. Optimal control of intrapartum CBG (60-100mg/dL) during the last 6 hours of labor was associated with a 64% reduction in the neonatal hypoglycemia incidence.
527 Fetal gender and maternal insulin resistance during mid-pregnancy Ichiro Yasuhi, Hiroshi Yamashita, Sachie Suga, Misao Fukuoka, Megumi Koga, So Sugimi, Yasushi Umezaki, Masashi Fukuda, Nobuko Kusuda NHO Nagasaki Medical Center, Omura-City, Japan
OBJECTIVE: Recent studies have suggested that fetal sex influences maternal insulin dynamics during pregnancy. We examined whether the difference in fetal sex is associated with maternal insulin resistance and b-cell function during pregnancy. STUDY DESIGN: We included singleton women who underwent the 75gOGTT between 24 and 34 weeks’ gestation due to a positive diabetic screen. In addition to plasma glucose (PG), we measured plasma insulin during the OGTT to obtain surrogate indices associated with insulin resistance (IR), including homeostasis assessment model (HOMA)-IR and insulin sensitivity index (IsOGTT), and b-cell function, including insulinogenic index (II) and HOMA-b. We compared those indices between women bearing male vs. female fetuses. RESULTS: We included 617 women aged 32.44.9 years with a mean prepregnancy body mass index (BMI) of 22.64.5. They underwent the 75g-OGTT at 29.02.5 weeks, and 258 (42%) women were diagnosed with gestational diabetes (GDM). There was no significant difference in maternal age, prepregnancy BMI, gestational age at OGTT, PG at OGTT, or the prevalence of GDM between women with a male fetus (n¼338) (male group) and female fetus (n¼279) (female group). Regarding the indices of IR, IR was significantly higher and insulin sensitivity was lower in the female fetus group than in the male fetus group (Table). Those differences remained significant after adjusting for maternal age, prepregnancy BMI, gestational age and fasting PG at OGTT, and GDM diagnosis. In contrast, the b-cell function did not differ markedly between the groups. CONCLUSION: Maternal IR was significantly higher in women bearing a female fetus than in those bearing a male fetus after adjusting for confounders. The gender of the fetus may affect maternal insulin sensitivity during mid-pregnancy.
Supplement to JANUARY 2017 American Journal of Obstetrics & Gynecology
S311