Insulin Resistance Is Associated with Gestational Hypertension and Not with Preeclampsia: A Population-Based Screening Study

Kun, Attila

doi:10.1159/000320326

Cited by 9 publications

(5 citation statements)

References 50 publications

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“…In addition, 34.69% of the studies were conducted in the U.S. [22,24,25,31,33,34,[36][37][38]41,44,52,53,55,57,58,64], 14.2% in Australia [20,27,28,50,51,65,68], 28.5% in Asia [26,29,32,35,39,40,42,[46][47][48][49]60,63,66], and 22.4% in Europe [21,23,30,43,45,54,56,59,61,62,67].…”

Section: Literature Search Results and Quality Assessmentmentioning

confidence: 99%

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Tehrani

Naz

Behboudi‐Gandevani

2021

JCM

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This systematic review and meta-analysis aimed to examine the impact of different gestational-diabetes (GDM) diagnostic-criteria on the risk of adverse-maternal-outcomes. The search process encompassed PubMed (Medline), Scopus, and Web of Science databases to retrieve original, population-based studies with the universal GDM screening approach, published in English language and with a focus on adverse-maternal-outcomes up to January 2020. According to GDM diagnostic criteria, the studies were classified into seven groups. A total of 49 population-based studies consisting of 1409018 pregnant women with GDM and 7,667,546 non-GDM counterparts were selected for data analysis and knowledge synthesis. Accordingly, the risk of adverse-maternal-outcomes including primary-cesarean, induction of labor, maternal-hemorrhage, and pregnancy-related-hypertension, overall, regardless of GDM diagnostic-criteria and in all diagnostic-criteria subgroups were significantly higher than non-GDM counterparts. However, in meta-regression, the increased risk was not influenced by the GDM diagnostic-classification and the magnitude of the risks among patients, using the IADPSG criteria-classification as the most strict-criteria, was similar to other criteria. In conclusion, a reduction in the diagnostic-threshold increased the prevalence of GDM, but the risk of adverse-maternal-outcome was not different among those women who were diagnosed through more or less intensive strategies. Our review findings can empower health-care-providers to select the most cost-effective approach for the screening of GDM among pregnant women.

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Section: Literature Search Results and Quality Assessmentmentioning

confidence: 99%

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

Tehrani

Naz

Behboudi‐Gandevani

2021

JCM

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“…Previous studies have shown similar comprehensive results. A cohort study including 2954 singleton pregnancies suggested that insulin resistance on an OGTT was associated with later development of gestational hypertension, but not preeclampsia, independent of maternal BMI [21]. Another study suggested that women who develop pregnancy-induced hypertension may be metabolically challenged at early stages of pregnancy with hyperinsulinism and insulin insensitivity [22].…”

Section: Discussionmentioning

confidence: 99%

The Area under the Curve (AUC) of Oral Glucose Tolerance Test (OGTT) Could Be a Measure Method of Hyperglycemia in All Pregnant Women

Zhang¹,

Wei²,

Sun³

et al. 2019

OJOG

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Objective: We adopted the area under the curve (AUC) of oral glucose tolerance test (OGTT) as a measure method of the severity of maternal hyperglycemia and investigated its relationship with adverse perinatal outcomes among women with and without gestational diabetes mellitus (GDM). Research design and methods: This is a retrospective cohort study. Our study group collected the medical records of 15,296 women who received perinatal care in 15 hospitals in Beijing and who delivered from July 1, 2013, to December 31, 2013. And several original articles on this cohort have been published. In this study, we analyze the relationship between AUC and adverse perinatal outcomes, so that in multiple pregnant cases, patients with pre-pregnancy diabetes, hypertension, and abnormal kidney function and those who did not receive a 75-g OGTT were excluded. A Chi-squared test and logistic regression analysis were used to determine the associations. Results: In total, 13,561 women were included. As the AUC of OGTT increased, the prevalence of macrosomia (odds ratio [OR] 1.059, 95% confidence interval [95% CI] 1.029-1.090, p < 0.001) and hypertensive diseases (OR 1.106, 95% CI 1.064-1.149, p < 0.001) also increased. For patients with same levels of AUC values, no significant differences in the risk of macrosomia, preterm birth and neonatal complications were observed between the GDM and non-GDM groups. Women with an AUC higher than 14.20 (mmol * h/L) had a higher risk of adverse outcomes regardless of the presence of GDM. Conclusions: The AUC could be a measure method of the severity of maternal hyperglycemia, and women with a high AUC should undergo aggressive management to avoid adverse outcomes regardless of the presence of GDM.

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“…FCGR is a measure of the amount of insulin secreted for a corresponding glucose level, and is considered a simplified index in the evaluation of insulin resistance compared with the euglycemic hyperinsulinemic clamp, which was regarded as the previous “gold standard”. In the study by Wang ( 28 ) and some other investigators ( 26 , 27 , 29 ), the fCGR index significantly increased in individuals with insulin resistance, and it was reported to present satisfactory specificity and sensitivity compared with euglycemic hyperinsulinemic clamps and HOMA indices. The results of our study therefore suggest that the level of insulin resistance in female MACS patients improves with the decline in autonomous cortisol secretion, and that this relationship only appears in premenopausal women with MACS and who manifest overt increases in autonomous cortisol secretion.…”

Section: Discussionmentioning

confidence: 92%

Sex Differences in Hypercortisolism and Glucose-Metabolism Disturbances in Patients with Mild Autonomous Cortisol Secretion: Findings From a Single Center in China

et al. 2022

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Background and objectiveMild autonomous cortisol secretion (MACS) presents with a marked female preponderance, but whether the sex difference in its distribution has any relevance to the presentation and outcome of the disease is unknown. The aim of this study was therefore to compare biochemical indices of hypercortisolism and impaired glucose metabolism between male and female patients with MACS.MethodWe enrolled a total of 98 patients with autonomous/possible autonomous cortisol secretion in our study, and indices of hypercortisolism and glucose metabolism were collected and compared between the male and female patients. Logistic regression models were used to evaluate the association between sex and cortisol-secretory ability, as well as between the latter and glucose metabolism. In addition, we conducted further stratified analyses according to the degree of autonomous cortisol secretion and menopausal status.ResultsCortisol levels at 00:00 and 08:00 h after a 1-mg dexamethasone suppression test (DST) and low-dose DST were significantly higher in female than in male MACS patients, and the inhibition rate of 1-mg DST was lower in the women than in the men. This significant difference still remained after adjusting for age, BMI, and the course of the disease. Logistic regression analysis revealed a significant association between autonomous cortisol secretion and fasting C-peptide, as well as with the C-peptide-to-glucose ratio in females relative to male patients. In addition, stratified analyses indicated that this association was observed only among women with autonomous cortisol secretion and who were premenopausal.ConclusionThe level of autonomic cortisol secretion in female patients with MACS was higher than in male patients, and the association between autonomous cortisol secretory ability and glucose homeostasis was only noted in patients with autonomous cortisol secretion and in premenopausal women. This phenomenon will, however, require closer follow-up.

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Insulin Resistance Is Associated with Gestational Hypertension and Not with Preeclampsia: A Population-Based Screening Study

Cited by 9 publications

References 50 publications

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

The Impact of Diagnostic Criteria for Gestational Diabetes Mellitus on Adverse Maternal Outcomes: A Systematic Review and Meta-Analysis

The Area under the Curve (AUC) of Oral Glucose Tolerance Test (OGTT) Could Be a Measure Method of Hyperglycemia in All Pregnant Women

Sex Differences in Hypercortisolism and Glucose-Metabolism Disturbances in Patients with Mild Autonomous Cortisol Secretion: Findings From a Single Center in China

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