Insulin Resistance in Women with Recurrent Spontaneous Miscarriage of Unknown Aetiology

Abstract

Objective: The objective of this study was to explore the role of insulin resistance in women with recurrent spontaneous miscarriage (RSM). Patients with ≧3 consecutive spontaneous miscarriages were classified as having RSM. Subjects and Methods: Thirty-five non-pregnant women presenting with RSM in our specialized RSM clinic constituted the study population, while 30 non-pregnant, parous, fertile women without RSM served as controls. The study and control patients were matched for age, ethnicity and body mass index (BMI). Blood was extracted from these patients for fasting blood glucose and fasting insulin simultaneously, and a battery of investigations including ultrasonography was performed on all the patients with RSM. Results: There was no significant difference in the mean fasting glucose for the study and control patients (5.5 ± 0.7 vs. 5.3 ± 0.6 mmol/dl) and in the mean fasting insulin (15.0 ± 5.1 and 12.9 ± 2.9 mU/l). There was a significant difference between the mean parity of the study and control patients (0.7 ± 0.7 vs. 1.7 ± 0.5, p < 0.0001) and also the mean number of miscarriages (4.2 ± 1.2 vs. 0.1 ± 0.4, p < 0.0001). There was, however, no significant difference in the insulin resistance of both groups as calculated using the Homeostasis Model Assessment and the fasting glucose insulin ratio of <4.5. Conclusion: Insulin resistance was not significantly associated with RSM in our study. Further studies may be needed.

Relationship between Recurrent Miscarriage and Insulin Resistance

“…Recent work has considered whether women who have had recurrent miscarriage have IR [7,8,9]. However, only FG has been examined.…”

“…Li et al [8] undertook a cohort study involving 107 patients who received assisted reproductive treatment and found that IR may be a risk factor for spontaneous miscarriage, independent of PCOS and obesity. Diejomaoh et al [9] administered the same test as Craig et al [7] on 35 subjects who had experienced 3 consecutive miscarriages. The results showed that although the FG and FI levels and the proportion of IR in the observation group were higher compared with the control group, the differences were not statistically significant.…”

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

“…Hyperinsulinaemia, increased insulin resistance and hyperandrogenaemia, which have all been reported in PCOS, have been linked with an increased risk of miscarriage and RSM. Although an increased prevalence of insulin resistance was reported in non-pregnant women with RSM compared with matched fertile controls in Craig et al [67], this was not confirmed in another study [68]. The recent study of Wang et al [69] showed that there was an increased risk of insulin resistance in the early stages of pregnancy in women with a history of RSM compared with those without such a history.…”

“…The aetiology of RSM may be multifactorial in many patients, with 2-3 different causes reported in the same patient [1,3,4,5,15]. In spite of the array of causes listed in table 1, there is still a huge challenge in identifying the causes of RSM in the patients who present to the clinics for investigation, especially as no cause may be identified in 40-60% of patients.…”

“…The incidence of RSM in women of reproductive age seeking pregnancies is reported to be 1-2% [1,2,3,6,13,14]. RSM, which is distressing to the affected families [13] and the couple seeking parenthood, has been a formidable challenge for the treating physician [15]; it has also been regarded as a heartbreaking and frustrating condition [16]. Patients presenting with RSM have experienced psychological trauma as they face the uncertainty of the outcome of the next pregnancy, and a variety of psychological and psychiatric disorders including anxiety, depression, posttraumatic stress disorders, and obsessive-compulsive disorders develop in these patients after RSM [17].…”