Maternal Characteristics Influencing the Development of Gestational Diabetes in Obese Women Receiving 17-alpha-Hydroxyprogesterone Caproate

Abstract

Objective. Gestational diabetes (GDM) and obesity portend a high risk for subsequent type 2 diabetes. We examined maternal factors influencing the development of gestational diabetes (GDM) in obese women receiving 17-alpha-hydroxyprogesterone caproate (17OHPC) for preterm delivery prevention. Materials and Methods. Retrospectively identified were 899 singleton pregnancies with maternal prepregnancy body mass indices of ≥30 kg/m2 enrolled for either 17OHPC weekly administration (study group) or daily uterine monitoring and nursing assessment (control group). Patients with history of diabetes type 1, 2, or GDM were excluded. Maternal characteristics were compared between groups and for women with and without development of GDM. A logistic regression model was performed on incidence of GDM, controlling for significant univariate factors. Results. The overall incidence of GDM in the 899 obese women studied was 11.9%. The incidence of GDM in the study group (n = 491) was 13.8% versus 9.6% in the control group (n = 408) (P = 0.048). Aside from earlier initiation of 17OHP and advanced maternal age, other factors including African American race, differing degrees of obesity, and use of tocolysis were not significant risks for the development of GDM. Conclusion. In obese women with age greater than 35 years, earlier initiation of 17OHPC may increase the risk for GDM.

Relationship between threatened miscarriage and gestational diabetes mellitus

“… SGA small for gestational age: <10th percentile, AGA appropriate for gestational age: 10th–90th percentile, LGA large for gestational age: >90th percentile, Macrosomia Estimated fetal weight ≥ 4 kg [ 25 ] a Missing data are excluded from statistical analyses b Chi-square test or Fisher’s exact test for categorical variables and Wilcoxon rank sum test for continuous variables c Univariate logistic regression …”

“…SGA small for gestational age: <10th percentile, AGA appropriate for gestational age: 10th–90th percentile, LGA large for gestational age: >90th percentile, Macrosomia Estimated fetal weight ≥ 4 kg [ 25 ]…”

“…Several studies in rats, mice, and adipocytes have reported that progesterone induces insulin resistance by multiple mechanisms during pregnancy [ 22 – 24 ]. The use of 17-alpha hydroxyprogesterone caproate for preterm delivery prevention is associated with an increased risk of developing GDM [ 25 , 26 ]. Therefore, we hypothesized that women with threatened miscarriage possess lower levels of progesterone throughout pregnancy than those without threatened miscarriage.…”

Is vaginal progesterone treatment associated with the development of gestational diabetes? A retrospective case–control study

“…Studies on the diabetogenic effect of progesterone supplementation have yielded inconclusive results. A number of studies have suggested that intramuscular administration of 17-alpha hydroxyprogesterone caproate (17 OHP-C) might pose a risk of increasing the incidence of GDM [ 8 , 11 – 13 ]. On the other hand, a secondary analysis of two randomized placebo-controlled trials of 17 OHP-C found no association with higher rates of GDM in either group [ 14 ].…”

“…Although the diabetogenic effects of progesterone supplementation have been investigated in in vitro [ 9 , 10 ] as well as in retrospective [ 8 , 11 , 12 ] and prospective [ 13 – 15 ] studies, the results remain inconclusive. Women with an increased risk for preterm delivery due to shortened cervical length with a transvaginal ultrasound scan carried out between 16 + 0 and 24 + 0 weeks of pregnancy showing a cervical length of < 25 mm and/or history of a previous preterm birth in our department routinely receive vaginal progesterone treatment starting at 16–20 weeks of gestation until 36 weeks of gestation in an attempt to prolong pregnancy.…”