Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycaemic clamp technique

Stanley, Katherine; Fraser, Robert; Bruce, Christine

doi:10.1111/j.1471-0528.1998.tb10207.x

Cited by 77 publications

(54 citation statements)

References 19 publications

(26 reference statements)

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“…These findings therefore suggest that there is progressive rise in insulin secretion as the pregnancy advances, indirectly signifying an increase in IR as the pregnancy advances. Similar finding had been reported by Stanley K et al, [12]. Catalano P et al, found significant 65% increase in both basal insulin and C-peptide concentrations in all subjects with advancing gestation [22].…”

Section: Discussionsupporting

confidence: 89%

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Normal Pregnancy- A State of Insulin Resistance

Biradar

Murthy

2014

JCDR

185

154

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Section: Discussionsupporting

confidence: 89%

“…Available literature [12][13][14] suggests that there is a rise in IR in 3 rd trimester of pregnancy. However literature is less on the 1 st and 2 nd trimester.…”

Section: Resultsmentioning

confidence: 99%

Normal Pregnancy- A State of Insulin Resistance

Biradar

Murthy

2014

JCDR

185

154

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“…Furthermore, the gestational period examined in this study is before the time when most of the physiological insulin resistance of pregnancy occurs, 35 so the insulin resistance that we detected may, in some cases, have already existed before the pregnancy. This has important future therapeutic implications.…”

Section: Perspectivesmentioning

confidence: 99%

Preeclampsia in Lean Normotensive Normotolerant Pregnant Women Can Be Predicted by Simple Insulin Sensitivity Indexes

et al. 2006

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Abstract-Certain similarities between preeclampsia and insulin resistance syndrome suggest a possible link between the 2 diseases. The aim of our study was to evaluate 3 insulin sensitivity (IS) indexes (fasting homeostasis model assessment IS [IS HOMA ], quantitative insulin sensitivity check index [IS QUICKI ], and oral glucose IS [OGIS]) early and late in pregnancy in a large number of normotensive pregnant women with a normal glucose tolerance and to test the ability of these indexes to predict the risk of subsequent preeclampsia. In all, 829 pregnant women were tested with a 75-g, 2-hour oral glucose load in 2 periods of pregnancy: early (16 to 20 weeks) and late (26 to 30 weeks). In early and late pregnancy, respectively, IS HOMA was 1.23Ϯ0.05 and 1.44Ϯ0.05 (PϽ0.01), IS QUICKI was 0.40Ϯ0.002 and 0.38Ϯ0.002 (PϽ0.01), and OGIS was 457Ϯ2.4 mL min Ϫ1 m Ϫ2 and 445Ϯ2.2 (PϽ0.001), all confirming the reduction in insulin sensitivity during pregnancy. Preeclampsia developed in 6.4% of the pregnant women and correlated positively with the 75th centile of IS HOMA (Pϭ0.001), with a sensitivity of 79% in the early and 83% in the late period and a specificity of 97% in both. IS QUICKI Ͻ25th centile was also related with preeclampsia (Pϭ0.001), with a sensitivity of 85% in the early and 88% in the late period and a specificity of 97% in both. Judging from our findings, IS HOMA and IS QUICKI are simple tests that can pinpoint impaired insulin sensitivity early in the pregnancy. Given their high sensitivity and specificity, these indexes could be useful in predicting the development of preeclampsia in early pregnancy, before the disease become clinically evident. Key Words: pregnancy Ⅲ metabolism Ⅲ insulin Ⅲ insulin resistance Ⅲ hypertension, pregnancy Ⅲ preeclampsia N ormal pregnancy can be considered as a state of insulin resistance, and fasting insulin concentrations double during the course of gestation. Insulin resistance peaks in the 3rd trimester and rapidly returns to prepregnancy levels after delivery. 1 The reasons for this insulin resistance in normal pregnancy are not well known, although it has been suggested that placental hormones, such as lactogen, cortisol, progesterone, and estrogen, 2 and tumor necrosis factor ␣ 3 may be responsible.A number of standard clinical procedures are available for evaluating maternal insulin sensitivity during pregnancy, such as the euglycemic-hyperinsulinemic clamp, the oral and intravenous glucose tolerance tests (OGTT and IVGTT, respectively), and various derivations of fasting glucose and insulin levels, 1,4 including the fasting homeostasis model assessment insulin sensitivity index (IS HOMA ) 5 and the quantitative insulin sensitivity check index [IS QUICKI ]. 6 The oral glucose insulin sensitivity index (OGIS), for instance, is a widely used index of dynamic insulin sensitivity by assessing glucose clearance during an OGTT. 7 Preeclampsia is a complication of late pregnancy characterized mainly by hypertension and proteinuria. 8 It is a major cause of perinatal and ma...

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“…Pregnancy is related to glucose metabolism disorders and insulin resistance (Hadden and McLaughlin, 2009;Johnson, 2008;Stanley et al, 1998). Insulin resistance may facilitate supply of appropriate nutrients particularly of glucose to fetus for fetal growth and metabolism.…”

Section: Introductionmentioning

confidence: 99%

“…Resistin is another protein identified recently as a hormone secreted by adipocytes which has a controversial history regarding its role in the pathogenesis of obesity-mediated insulin resistance and type 2 diabetes (Lu et al, 2006;Hasegawa et al, 2005;Hivert et al, 2008). Insulin sensivity changes from an enhanced state during early pregnancy to an insulin resistant state in late pregnancy (Kirwan et al, 2002;Leturque et al, 1984;Stanley et al, 1998). Therefore it is inspected, subsequent to increase in IR during pregnancy, its related factors change, too.…”

Section: Introductionmentioning

confidence: 99%

Do Resistin and Tumor Necrosis Factor-Î± Relate to Changes in Insulin Resistance in Normal Pregnancy?

Zareian¹,

Jahromi²,

Rad³

et al. 2010

American Journal of Biochemistry and Biotechnology

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Problem statement:The purpose of this study was to evaluate the role of resistin and Tumor Necrosis Factor-α (TNF-α) in insulin resistance during pregnancy. Approach: Serum resistin and TNF-α concentrations were measured by ELISA in 86 healthy pregnant women (26, 23 and 37 of them in the 1st, 2nd and 3rd trimesters, respectively) and in 21 healthy non pregnant women in a cross sectional study. Results: Resistin concentration was significantly higher in the third trimester (9.5±3.3 ng mL −1 ) as compared with non pregnant women (7±3.3 ng mL −1 ). Serum TNF-α level were also significantly increase in pregnant women (2.6±1.9 pg mL −1 ) as compared with maternal healthy controls (0.8 ±0.7 pg mL −1 ). There were significant correlation between gestational age and BMI (r = 0.28, p = 0.01), resistin (r = 0.36, p = 0.002) and TNF-α (r = -0.44, p<0.0001). There was not significant correlation between gestational age and Insulin Resistance (IR). We also did not found correlation between IR and resistin as well as between IR and TNF-α in pregnant women. Conclusion: TNF-α and resistin do not appear to contribute greatly to pregnancy induced insulin resistance in healthy pregnancy.

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Physiological changes in insulin resistance in human pregnancy: longitudinal study with the hyperinsulinaemic euglycaemic clamp technique

Cited by 77 publications

References 19 publications

Normal Pregnancy- A State of Insulin Resistance

Normal Pregnancy- A State of Insulin Resistance

Preeclampsia in Lean Normotensive Normotolerant Pregnant Women Can Be Predicted by Simple Insulin Sensitivity Indexes

Do Resistin and Tumor Necrosis Factor-Î± Relate to Changes in Insulin Resistance in Normal Pregnancy?

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