Relationship between Recurrent Miscarriage and Insulin Resistance

Wang, Yunhui; Zhao, Haixia; Li, Yan; Zhang, Jianping; Tan, Jiewen; Liu, Yukun

doi:10.1159/000325165

Cited by 31 publications

(25 citation statements)

References 35 publications

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“…Studies conducted by Wang Y Zhao et al, Kotanaie Maryam et al and KA Wahba et al observed similar results. 6,32,35 It was noted that the mean glucose insulin ratio in the study group was 8.1+3.39 and in control group was 17.8+11.44, while comparing the two groups statistically significant difference was found with a p value of 0<.001. Similar inferences were made by Celik Nazan et al where the mean glucose insulin ratio in the study group was 12.2+13.5 and in the control group was 28.3+15.4 with statistically significant difference (p value <0.001).…”

Section: Resultsmentioning

confidence: 91%

Relationship of insulin resistance with recurrent pregnancy loss

Wani

Gul

Jabeen

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: The recurrent pregnancy loss (RPL) is defined as two and more failed pregnancies as documented by ultrasound and histopathological examination and suggested some assessment after each loss with a thorough evaluation after three or more losses. RPL is one of the most frustrating and difficult areas in reproductive medicine because the aetiology is often unknown and there are few evidence based diagnostic and treatment strategies.Methods: 150 Non pregnant females were taken as both cases and controls in the study. All the pregnancy losses were documented by ultrasound or histological examination after uterine curettage. The control group consisted of women with no RPL with at least one live birth. These two groups were matched on the basis of age and BMI. All the women underwent following examinations, viz. Hysterosalpingography, karyotype of both partners, serum TSH, FT4, prolactin and antibodies for APLA. In addition blood sample were taken for fasting serum glucose and serum insulin level later insulin resistance was calculate using three parameters Fasting insulin > 20IU/ml. Diagnostic of Insulin Resistance. (2) Fasting glucose / Fasting insulin. A ratio of < 4.5 being diagnostic of insulin resistance. (3) HOMA IR. FG (mg/dl) x FPI (IU/ml) FG (mmol/l) x FPI (IU/ml)------------------------------------ OR ----------------------------------- 405 22.5Where 1 mmol/l = 18mg/dl, A value of > 4.5 being diagnostic of insulin resistance.Results: 150 patients were enrolled in this study among which 75 were selected as cases and 75 as controls after fulfilling inclusion and exclusion criteria with mean age cases group was28.4+2.37 years and 29.1+2.70 years in control group mean miscarriage rate in study group was 3.17+83 and control group with 0.35+0.48 with statistically significant difference. Mean fasting glucose (96.5+ 7.86) mg/dl, Fasting Insulin (14.1±5.91) IU/ml. Mean Glucose Insulin ratio (8.1±3.39), HOMA-IR (3.4 ±1.51) in the study group and in control group mean fasting glucose was (87.1+11.49) mg/dl, Fasting Insulin (6.9 ± 4.99) IU/ml. Mean Glucose Insulin ratio (17.8 ±11.44), HOMA-IR (1.5 ±1.27) respectively with statistically significant difference.Conclusions: In women with recurrent pregnancy loss fasting insulin and insulin resistance are higher than those in women without spontaneous abortion. The most sensitive parameter for calculating insulin resistance was found to be fasting insulin followed by HOMA – IR and followed by fasting glucose/fasting insulin ratio. It is therefore important to recommend a fasting insulin and fasting glucose level while evaluating a case of recurrent pregnancy loss to assess for insulin resistance.

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Section: Resultsmentioning

confidence: 91%

Relationship of insulin resistance with recurrent pregnancy loss

Wani

Gul

Jabeen

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…Possible shared pathways include cervical insufficiency and infections,141628293031 although these are speculative. There are a few clues in the literature suggesting that glucose metabolism abnormalities could increase both the risk of miscarriage and preterm delivery 32333435…”

Section: Discussionmentioning

confidence: 99%

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

Magnus

Wilcox

Morken

et al. 2019

BMJ

370

227

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Objectives To estimate the burden of miscarriage in the Norwegian population and to evaluate the associations with maternal age and pregnancy history. Design Prospective register based study. Setting Medical Birth Register of Norway, the Norwegian Patient Register, and the induced abortion register. Participants All Norwegian women that were pregnant between 2009-13. Main outcome measure Risk of miscarriage according to the woman’s age and pregnancy history estimated by logistic regression. Results There were 421 201 pregnancies during the study period. The risk of miscarriage was lowest in women aged 25-29 (10%), and rose rapidly after age 30, reaching 53% in women aged 45 and over. There was a strong recurrence risk of miscarriage, with age adjusted odds ratios of 1.54 (95% confidence interval 1.48 to 1.60) after one miscarriage, 2.21 (2.03 to 2.41) after two, and 3.97 (3.29 to 4.78) after three consecutive miscarriages. The risk of miscarriage was modestly increased if the previous birth ended in a preterm delivery (adjusted odds ratio 1.22, 95% confidence interval 1.12 to 1.29), stillbirth (1.30, 1.11 to 1.53), caesarean section (1.16, 1.12 to 1.21), or if the woman had gestational diabetes in the previous pregnancy (1.19, 1.05 to 1.36). The risk of miscarriage was slightly higher in women who themselves had been small for gestational age (1.08, 1.04 to 1.13). Conclusions The risk of miscarriage varies greatly with maternal age, shows a strong pattern of recurrence, and is also increased after some adverse pregnancy outcomes. Miscarriage and other pregnancy complications might share underlying causes, which could be biological conditions or unmeasured common risk factors.

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“…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.…”

Section: The Aetiology Of Rsmmentioning

confidence: 94%

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

Diejomaoh¹

2014

Med Princ Pract

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Recurrent spontaneous miscarriage (RSM), affecting 1-2% of women of reproductive age seeking pregnancy, has been a clinical quagmire and a formidable challenge for the treating physician. There are many areas of controversy in the definition, aetiology, investigations and treatment of RSM. This review will address the many factors involved in the aetiology of RSM which is multifactorial in many patients, with antiphospholipid syndrome (APS) being the most recognized aetiological factor. There is no identifiable cause in about 40-60% of these patients, in which case the condition is classified as idiopathic or unexplained RSM. The RSM investigations are extensive and should be undertaken in dedicated, specialized, well-equipped clinics/centres where services are provided by trained specialists. The challenges faced by the treating physician are even more overwhelming regarding the decision of what should be the most appropriate therapy offered to patients with RSM. Our review will cover the diverse modalities of therapy available including the role of preimplantation genetic testing using recent microarray technology, such as single nucleotide polymorphism and comparative genomic hybridization, as well as preimplantation genetic diagnosis; the greatest emphasis will be on the treatment of APS, and there will be important comments on the management of patients presenting with idiopathic RSM. The controversial areas of the role of natural killer cells in RSM, the varied modalities in the management of idiopathic RSM and the need for better-planned studies will be covered as well.

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Relationship between Recurrent Miscarriage and Insulin Resistance

Cited by 31 publications

References 35 publications

Relationship of insulin resistance with recurrent pregnancy loss

Relationship of insulin resistance with recurrent pregnancy loss

Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study

Recurrent Spontaneous Miscarriage Is Still a Challenging Diagnostic and Therapeutic Quagmire

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