Insulin Resistance and Gestational Diabetes Mellitus in Pregnancy – a Tertiary Care Hospital Based Study

Insulin Resistance and Gestational Diabetes Mellitus in Pregnancy – a Tertiary Care Hospital Based Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Insulin Resistance and Gestational Diabetes Mellitus in Pregnancy – a Tertiary Care Hospital Based Study Prashant Nigam, Aradhana Gupta, Himanshi Singh, Piyu Sahu, Pragya Shalini Minj, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4742399/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background - Pregnancy triggers numerous changes in metabolism, biochemistry, physiology, hematology, and immunity. Healthy pregnant women may develop resistance to insulin's effects on glucose absorption and utilization. The TG/HDL has been advocated as a simple clinical indicator of insulin resistance. The relationship between lipid profiles, insulin resistance and gestational diabetes mellitus (GDM) remains controversial. Aim - This research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) as a marker for Insulin resistance and the association of IR and GDM in pregnancy. Materials and methods - The study included 1040 pregnant mothers selected randomly attending for routine antenatal checkup. The study participants were in the age group of 18-40 years. OGTT is performed in pregnant women by measuring the plasma glucose after 2 hours of fasting or non-fasting after ingesting 75 grams of glucose. A single value of ≥140 mg/dl is diagnostic for Gestational Diabetes Mellitus according to Technical and operational guidelines of diagnosis and management of GDM by MOHFW, Govt of India. Lipid parameters and IR was also looked for. Results - OGTT, IR, TC, TG, VLDL was found to be significantly elevated among GDM mothers. GDM and IR was found to increase as maternal age increases. OGTT has been found to be significantly positively correlated to IR. Also TC was found to be significantly correlated to LDL. Conclusion - A positive correlation between total cholesterol, and insulin resistance shows that as cholesterol levels rise, insulin resistance also increases, elevating the risk of GDM. These correlations are crucial for understanding the metabolic health implications in pregnant women. It is concluded that due to alterations in lipid parameters, insulin resistance in pregnant women increases which causes a significant impact on Gestational Diabetes Mellitus. Gestational Diabetes Mellitus (GDM) Insulin Resistance (IR) Total Cholesterol (TC) Triglycerides (TG) Low-density lipoprotein (LDL) High-density lipoprotein (HDL) Very Low-density lipoprotein (VLDL). Figures Figure 1 Figure 2 INTRODUCTION Pregnancy triggers numerous changes in metabolism, biochemistry, physiology, hematology, and immunity. These alterations are typically reversible after delivery if there are no complications at full term. Healthy pregnant women may develop resistance to insulin's effects on glucose absorption and utilization. [1] Insulin resistance (IR) refers to the reduced ability of target tissues—such as muscle, adipose tissue, and the liver to respond to normal insulin levels in the blood. [2] Placenta secretes a series of pregnancy-specific hormones called “placental hormones” are believed to represent a major factor in reprogramming maternal physiology to achieve an insulin resistant state. [3] Gestational diabetes is defined as "any degree of glucose intolerance with onset or first recognition during pregnancy beyond 24-28 weeks of gestation". [4] OGTT is performed in pregnant women by measuring the plasma glucose after 2 hours of fasting or non-fasting after ingesting 75 grams of glucose. The Indian Guidelines (DIPSI Test) are simple for diagnosing gestational diabetes (GDM). They can be done quickly in low-resource settings, where many pregnant women visit for ANC check-ups in a Non-fasting state. A single value of ≥140 mg/dl is diagnostic for Gestational Diabetes Mellitus according to Technical and operational guidelines of diagnosis and management of GDM by MOHFW, Govt of India. [5] Worsening physiological changes in glucose metabolism during pregnancy may contribute to GDM. It affects 15% to 22% of pregnancies globally, with its incidence on the rise. [6] As one of the most prevalent medical complications of pregnancy, GDM increases the risk of adverse pregnancy outcomes, including pregnancy-induced hypertension, miscarriage, preeclampsia, preterm delivery, premature rupture of membranes, and large-for-gestational-age infants. The relationship between lipid profiles and GDM remains controversial. Although lipid levels during pregnancy have been extensively studied, the findings are inconsistent. Some researchers have confirmed a significant increase in serum lipid profiles, including the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, in mothers with GDM compared to those with healthy pregnancies. [7] However, other studies have reported no significant differences in serum TG, TC, LDL, HDL, and the TG/HDL-C ratio between women with and without GDM. [8] Previous research has also identified a link between insulin resistance (IR), diabetes mellitus, and the TG/HDL-C ratio. [9,10] A TG/HDL ratio of ≥3 has been shown to be closely related to Insulin Resistance. [11,12] This research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) as a marker for Insulin resistance and the risk of gestational diabetes mellitus in pregnancy. MATERIALS AND METHODS The study was conducted at CIMS Bilaspur, Chhattisgarh, India, in compliance with the declaration of Helsinky after due approval of Institutional Ethics Committee. Participants were recruited after getting their informed consent. Sample size was calculated using Epi Info 1.4.3 (Fleiss with CC) considering two-sided confidence interval as 95, power as 90%, odds ratio as 1.55. The study included 1040 pregnant mothers selected randomly attending for routine antenatal checkup and not having any chronic medical illness. The study participants were in the age group of 18-40 years. History taking and general examination of participants was done, followed by collection blood samples. Five ml of blood samples were collected in clot activator and EDTA vacutainer tubes as required after overnight fasting of 8 hours and 2 hours post glucose load. Assessed glycemic parameters included OGTT. Similarly, serum lipid profile was assessed including fasting serum TC, TG, HDL, LDL and VLDL levels. All laboratory parameters were estimated spectrophotometrically following manufacturer’s guidelines on fully automated ILAB 650 clinical chemistry analyzer (Instrumentation Laboratory, USA). IR was calculated by TG/HDL ratio. Statistical analysis was done using Microsoft Excel 2019 and IBM SPSS v22.0. All descriptive parameters were reported as mean ± SD. Similarly, two tail Welch’s t test was done to compare the serum lipid profile parameters, IR, OGTT among GDM and with out GDM mothers, considering P value less than 0.05 as statistically significant. Correlation analysis was done to find inter-relationship between glycemic status, insulin resistance and serum lipid profile of cases. RESULT Glycemic status of pregnant women were determined by OGTT. Out of total 1040 cases, 3.17% (33) of the total cases were found to be having GDM and maximum of them were found to be in the higher age group of 31-40 years. IR was found to be in 48.46% (504) of the total cases and maximum IR cases (36.9%) were found in the age group of 21-30yrs . Though the rate of IR increased as maternal age increases where out of the total 156 pregnant mothers of 31-40yrs, 102 were found to be having IR which accounts for 65.38% of the cases of the age group 31-40yrs, as shown in table no 1 Table no 1: Age group wise distribution of Glycemic status and IR among the subjects by OGTT and TG/HDL ratio Glycemic status by OGTT IR by TG/HDL ratio Age range Without GDM (≤140 mg/dl) GDM (> 140 mg/dl) Without IR (<3) With IR (≥ 3) ≤20 52 (5%) 2 (0.19%) 36 (3.46%) 18 (1.73%) 21-30 823 (79.13%) 7 (0.67%) 448 (43.07%) 384 (36.9%) 31-40 132 (12.7%) 24 (2.3%) 54 (5.19%) 102 (9.8%) Total 1007 (96.8%) 33 (3.17%) 538 (51.73%) 504 (48.46%) Age wise distribution of Mean ± SD values of OGTT, IR and Lipid profile parameters are shown in table no 2 . It has been that maximum alteration in lipid profile and Insulin resistance was found to be in mothers with early onset of pregnancy Table 2: Mean ± SD of OGTT, IR and Lipid parameters age group wise among the pregnant mothers Age range OGTT (mg/dl) IR TC (mg/dl) TG (mg/dl) HDL (mg/dl) LDL (mg/dl) VLDL (mg/dl) ≤20 121±29.70 4.72±0.79 280.5±14.84 262.5±17.68 56±5.66 156±15.56 52.5±3.54 21-30 108.31±16.84 3.02±1.52 165.06±38.92 139.34±62.31 47.87±14.20 96.87±24.64 27.86±12.46 31-40 121.33±43.11 4.65±2.72 170.83±30.06 214.66±91.65 48±16.44 100.66±20.8 42.93±18.33 It has been seen that there is significant difference among the mean values of OGTT, IR , TC, TG, VLDL among the GDM mothers as compared to mothers without GDM as shown in the table 3 below Table -3 : Mean ± SD of glycemic and lipid parameters among the GDM and Non GDM mothers Without GDM With GDM P value OGTT (mg/dl) 106.48 ± 14.49 202 ± 65.76 0.002 IR 1.87 ± 0.48 3.39 ± 1.8 0.006 TC (mg/dl) 148.33 ± 27.64 173.59 ± 45.17 0.029 TG (mg/dl) 82.33 ± 48.12 162.88 ± 73.07 0.003 HDL (mg/dl) 48.26 ± 14.5 45.11 ± 7.09 0.493 LDL (mg/dl) 83.33 ± 15.69 101.78 ± 26.98 0.163 VLDL (mg/dl) 16.46 ± 9.62 32.56 ± 14.61 0.003 Table 4- Correlation and significance of OGTT with IR and lipid parameters OGTT Pearson Correlation P value IR 0.4659 0.0024 TC 0.0189 0.9077 LDL -0.0037 0.9814 Results of the correlation indicated that there is a significant medium positive relationship between OGTT and IR where (r = 0.4659, p = 0.0024). Also there is a non significant very small positive relationship between OGTT and TC where (r = 0.0189, p = 0.9077). Also there is a non significant very small negative relationship between OGTT and LDL where (r = -0.0037, p = 0.9814) as shown in table 4 (fig-1) Table 5- Correlation and significance of TC with IR and LDL in GDM mothers TC Pearson Correlation P value IR 0.2562 0.1106 LDL 0.8699 < 0.001 Results of the correlation indicated that there is a non significant small positive relationship between TC and IR where (r = 0.2562, p = 0.1106), and a significant large positive relationship between TC and LDL where (r = 0.8699, p < 0.001) as shown in table 5 (fig-2) DISCUSSION This research involved 1040 pregnant women of age group 18–40. This finding indicate that insulin resistance is more prevalent in pregnant women of age group 31–40. Furthermore, maximum GDM mothers were found majorly in this age group. Analyzing the lipid profile of these same cases, it is observed that lipid parameters like TC, TG, VLDL are significantly raised in the GDM mothers and also insulin resistance is also significantly raised . The connections between OGTT and insulin resistance have been examined in previous studies as suggested by (Ranganath Muniyappa et al. 2021). [ 13 ] This study involves assessing insulin sensitivity in humans and it showed that indices derived from OGTT are accurate in predicting insulin resistance. The correlation analysis revealed a significant medium positive relationship between OGTT and IR ( r = 0.4659, p = 0.0024 ). This suggests that as OGTT level increases IR also tend to increase. The correlation between TC and OGTT indicates that there is a non significant very small positive relationship between these two parameters ( r = 0.0189, p = 0.9077 ) aligning with the previous studies (F A Rahnemaei et al. 2021) [ 14 ] , (Zhang et al. 2022) [ 15 ] . It indicates that higher TC levels are linked to higher OGTT levels. The decreased concentration of TC, during OGTT, was related to an increased risk of postpartum abnormal glucose regulation in GDM women. The concentration of LDL is increased in pregnancy along with TC and TG due to the elevation in maternal estrogen level. LDL cholesterol constitutes a significant portion of total cholesterol and high levels of TC often reflect elevated LDL levels. This strong correlation underlies the use of both TC and LDL as key markers in cardiovascular risk assessment and guides clinical decisions in lipid management. [ 16 ] Results of the correlation indicated that there is a significant large positive relationship between TC and LDL ( r = 0.8699 , p < 0.001 ) (Mikael Huhtala et al. 2023). [ 17 ] Impaired glucose tolerance, identified by OGTT, often leads to higher LDL cholesterol levels due to insulin resistance. This condition increases cardiovascular risk. Early detection through OGTT can guide interventions to improve insulin sensitivity and lower LDL cholesterol. [ 18 ] Results of the correlation indicated that there is a non significant very small negative relationship between OGTT and LDL. ( r = -0.0037 , p = 0.9814 ), indicating that as OGTT levels increases there might be a decrease in LDL level. Conversely the studies of F A Rahnemaei et al. 2021 [ 14 ] shows contradicting results. The TG/HDL has been advocated as a simple clinical indicator of insulin resistance as studies done by Jui Kun Chiang et al 2011. [ 19 ] Insulin resistance is linked to higher total cholesterol, LDL cholesterol, and triglycerides, along with lower HDL cholesterol. Results of the correlation indicated that there is a non significant small positive relationship between TC and IR, ( r = 0.2562, p = 0.1106 ) with increase in level of TC, the level of IR tend to increase slightly. Similar results are unveiled in the studies of F A Rahnemaei et al. 2021. [ 14 ] Moreover it has been found that as maternal age increases the risk of GDM also increases as also found by Yu-Jin Koo et al 2012 . [ 20 ] With insulin resistance, the body's cells don't respond normally to insulin. Glucose can't enter the cells as easily, so it builds up in the blood. This can eventually lead to Type II diabetes mellitus. Though, increased insulin resistance is seen during the course of a healthy pregnancy. [ 21 ] During the early stages of normal pregnancies, the pancreatic β-cells secrete more insulin, which slows the rise in plasma glucose levels. This regulation explains the abnormally modest increases in plasma glucose levels brought on by elevated insulin resistance. IR is a state in which normal concentrations of insulin cannot elicit a response of target cells, and the negative feedback urges the body to secrete excess insulin. When insulin secretion fails to compensate for IR, Gestational Diabetes Mellitus emerges. Physiological IR during pregnancy is beneficial to fetal growth and can effectively supply nutrients but the degree of IR if significantly higher than that of normal pregnancy, which will cause many adverse effects on mother and fetus, such as preterm delivery, cesarean, macrosomia. [ 22 ] Individuals with GDM are more likely to acquire chronic insulin resistance because of the superimposition of lower insulin production by the cells in that condition (GDM) (Irfat Ara et al. 2022). [ 23 ] CONCLUSION The correlation between lipid parameters (TC, TG, HDL-C, LDL-C, VLDL) and IR, OGTT results, and GDM can vary. A positive correlation between total cholesterol, and insulin resistance shows that as cholesterol levels rise, insulin resistance also increases, elevating the risk of GDM and cardiovascular diseases and metabolic syndrome. Also, a significant positive correlation between TC and LDL which indicates that high TC increases the risk of LDL. Thus, better glucose tolerance is associated with lower IR, TC, TG levels, suggesting improved metabolic health, a reduced risk of cardiovascular disease and healthier metabolic profiles with lower lipid levels. The principal results of this study indicates that pregnant women of advanced maternal age group 31–40 years exhibits a higher incidence of gestational diabetes mellitus and insulin resistance. These correlations are crucial for understanding the metabolic health implications in pregnant women. It is concluded that due to alterations in lipid parameters, insulin resistance in pregnant women increases which causes a significant impact on Gestational Diabetes Mellitus. Declarations Author Contribution On behalf of all authors, I hereby affirm that all authors have read the manuscript and agreed to its submission. We hereby certify that this manuscript consists of original and unpublished work which is not under consideration for publication elsewhere. Further, all authors declare that they do not have any conflicts of interest. References Sonagra AD, Biradar SM, K D, Murthy D S J. Normal pregnancy- a state of insulin resistance. J Clin Diagn Res. 2014 Nov;8(11):CC01-3. doi: 10.7860/JCDR/2014/10068.5081. Epub 2014 Nov 20. PMID: 25584208; PMCID: PMC4290225. da Silva Rosa SC, Nayak N, Caymo AM, Gordon JW. Mechanisms of muscle insulin resistance and the cross‐talk with liver and adipose tissue. Physiological reports. 2020 Oct;8(19):e14607. Leoni M, Padilla N, Fabbri A, Della-Morte D, Ricordi C, Infante M. Mechanisms of Insulin Resistance during Pregnancy. InEvolving Concepts in Insulin Resistance 2022 Oct 6. IntechOpen. Quintanilla Rodriguez BS, Mahdy H. Gestational Diabetes. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545196/ Jain R, Olejas S, Goo LS, Bhavatharinin N, Dengra AS, Shoghli R, Davey S, Jain R. 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Insulin resistance is associated with an unfavorable serum lipoprotein lipid profile in women with newly diagnosed gestational diabetes. Biomolecules. 2023 Mar 3;13(3):470. Dannecker, C., Wagner, R., Peter, A., Hummel, J., Vosseler, A., Häring, H. U., Fritsche, A., Birkenfeld, A. L., Stefan, N., & Heni, M. (2021). Low-Density Lipoprotein Cholesterol Is Associated With Insulin Secretion. ˜the œJournal of Clinical Endocrinology and Metabolism/Journal of Clinical Endocrinology & Metabolism, 106(6), 1576–1584. https://doi.org/10.1210/clinem/dgab147 Chiang, J. K., Lai, N. S., Chang, J. K., & Koo, M. (2011). Predicting insulin resistance using the triglyceride-to-high-density lipoprotein cholesterol ratio in Taiwanese adults. Cardiovascular Diabetology, 10(1). https://doi.org/10.1186/1475-2840 Koo YJ, Ryu HM, Yang JH, Lim JH, Lee JE, Kim MY, Chung JH. Pregnancy outcomes according to increasing maternal age. Taiwanese Journal of Obstetrics and Gynecology. 2012 Mar 1;51(1):60-5. Motevalizadeh E, Díaz-López A, Martín F, Basora J, Arija V. Association of parity with insulin resistance early in pregnant women: ECLIPSES study. The Journal of Clinical Endocrinology & Metabolism. 2024 Mar;109(3):730-9. Sonagra AD, Biradar SM, K D, Murthy D S J. Normal pregnancy- a state of insulin resistance. J Clin Diagn Res. 2014 Nov;8(11):CC01-3. doi: 10.7860/JCDR/2014/10068.5081. Epub 2014 Nov 20. PMID: 25584208; PMCID: PMC4290225. Ara I, Maqbool M, Gani I. Role of insulin resistance in gestational diabetes mellitus: a literature review. Chettinad Health City Medical Journal (E-2278-2044 & P-2277-8845). 2022 Jun 30;11(2):69-74.. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4742399","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":327700687,"identity":"a5e4c6cd-a66a-4690-9080-df167bcb2a24","order_by":0,"name":"Prashant Nigam","email":"","orcid":"","institution":"Chhattisgarh Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Prashant","middleName":"","lastName":"Nigam","suffix":""},{"id":327700688,"identity":"7e281ebb-9e17-498a-ac13-8ad8e762a384","order_by":1,"name":"Aradhana Gupta","email":"","orcid":"","institution":"Guru Ghasidas 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These alterations are typically reversible after delivery if there are no complications at full term. Healthy pregnant women may develop resistance to insulin's effects on glucose absorption and utilization.\u003csup\u003e[1]\u003c/sup\u003e Insulin resistance (IR) refers to the reduced ability of target tissues—such as muscle, adipose tissue, and the liver to respond to normal insulin levels in the blood. \u003csup\u003e[2]\u0026nbsp;\u003c/sup\u003e Placenta secretes a series of pregnancy-specific hormones called “placental hormones” are believed to represent a major factor in reprogramming maternal physiology to achieve an insulin resistant state.\u003csup\u003e[3]\u0026nbsp;\u003c/sup\u003eGestational diabetes is defined as \"any degree of\u0026nbsp;glucose intolerance\u0026nbsp;with onset or first recognition during pregnancy beyond 24-28 weeks of gestation\".\u003csup\u003e[4]\u0026nbsp;\u003c/sup\u003eOGTT is performed in pregnant women by measuring the plasma glucose after 2 hours of fasting or non-fasting after ingesting 75 grams of glucose. The Indian Guidelines (DIPSI Test) are simple for diagnosing gestational diabetes (GDM). They can be done quickly in low-resource settings, where many pregnant women visit for ANC check-ups in a Non-fasting state. A single value of ≥140 mg/dl is diagnostic for Gestational Diabetes Mellitus according to Technical and operational guidelines of diagnosis and management of GDM by MOHFW, Govt of India. \u003csup\u003e[5]\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWorsening physiological changes in glucose metabolism during pregnancy may contribute to GDM. It affects 15% to 22% of pregnancies globally, with its incidence on the rise.\u003csup\u003e[6]\u003c/sup\u003e As one of the most prevalent medical complications of pregnancy, GDM increases the risk of adverse pregnancy outcomes, including pregnancy-induced hypertension, miscarriage, preeclampsia, preterm delivery, premature rupture of membranes, and large-for-gestational-age infants.\u003c/p\u003e\n\u003cp\u003eThe relationship between lipid profiles and GDM remains controversial. Although lipid levels during pregnancy have been extensively studied, the findings are inconsistent. Some researchers have confirmed a significant increase in serum lipid profiles, including the triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, in mothers with GDM compared to those with healthy pregnancies.\u003csup\u003e[7]\u003c/sup\u003e However, other studies have reported no significant differences in serum TG, TC, LDL, HDL, and the TG/HDL-C ratio between women with and without GDM.\u003csup\u003e[8]\u0026nbsp;\u003c/sup\u003ePrevious research has also identified a link between insulin resistance (IR), diabetes mellitus, and the TG/HDL-C ratio.\u003csup\u003e[9,10]\u003c/sup\u003e A TG/HDL ratio of ≥3 has been shown to be closely related to Insulin Resistance. \u003csup\u003e[11,12]\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThis research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) as a marker for Insulin resistance \u0026nbsp;and the risk of gestational diabetes mellitus in pregnancy.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThe study was conducted at CIMS Bilaspur, Chhattisgarh, India, in compliance with the declaration of Helsinky after due approval of Institutional Ethics Committee. Participants were recruited after getting their informed consent. Sample size was calculated using Epi Info 1.4.3 (Fleiss with CC) considering two-sided confidence interval as 95, power as 90%, odds ratio as 1.55. The study included 1040 pregnant mothers selected randomly attending for routine antenatal checkup and not having any chronic medical illness. The study participants were in the age group of 18-40 years.\u003c/p\u003e\n\u003cp\u003eHistory taking and general examination of participants was done, followed by collection blood samples. Five ml of blood samples were collected in clot activator and EDTA vacutainer tubes as required after overnight fasting of 8 hours and 2 hours post glucose load. Assessed glycemic parameters included OGTT. Similarly, serum lipid profile was assessed including fasting serum TC, TG, HDL, LDL and VLDL levels. All laboratory parameters were estimated spectrophotometrically following manufacturer’s guidelines on fully automated ILAB 650 clinical chemistry analyzer (Instrumentation Laboratory, USA). IR was calculated by TG/HDL ratio.\u003c/p\u003e\n\u003cp\u003eStatistical analysis was done using Microsoft Excel 2019 and IBM SPSS v22.0. All descriptive parameters were reported as mean ± SD. Similarly, two tail Welch’s t test was done to compare the serum lipid profile parameters, IR, OGTT among GDM and with out GDM mothers, considering P value less than 0.05 as statistically significant. Correlation analysis was done to find inter-relationship between glycemic status, insulin resistance and serum lipid profile of cases. \u0026nbsp;\u003c/p\u003e"},{"header":"RESULT","content":"\u003cp\u003eGlycemic status of pregnant women were determined by OGTT. Out of total 1040 cases, 3.17% (33) \u0026nbsp;of the total cases were found to be having GDM and maximum of them were found to be in the higher age group of 31-40 years. IR was found to be in 48.46% (504) of the total cases and maximum IR cases (36.9%) were found in the age group of 21-30yrs . Though the rate of IR increased as maternal age increases where out of the total 156 pregnant mothers of 31-40yrs, 102 were found to be having IR which accounts for 65.38% of the cases of the age group 31-40yrs, as shown in table no 1\u003c/p\u003e\n\u003cp\u003eTable no 1: Age group wise distribution of Glycemic status and IR among the subjects by OGTT and TG/HDL ratio\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.161616161616163%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"43.43434343434343%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eGlycemic status by OGTT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.4040404040404%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eIR by TG/HDL ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAge range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWithout GDM\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026le;140 mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGDM\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026gt; 140 mg/dl)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout IR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026lt;3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e\u003cstrong\u003eWith IR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(\u0026ge; 3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e\u0026le;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e52 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e2 (0.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e36 (3.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e18 (1.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e823 (79.13%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e7 (0.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e448 (43.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e384 (36.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e132 (12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e24 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e54 (5.19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e102 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eTotal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003e1007 (96.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\"\u003e\n \u003cp\u003e33 (3.17%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e538 (51.73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.408163265306122%\" valign=\"top\"\u003e\n \u003cp\u003e504 (48.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAge wise distribution of Mean \u0026plusmn; SD values of OGTT, IR and Lipid profile parameters are shown in table no 2 . It has been that maximum alteration in lipid profile \u0026nbsp;and Insulin resistance was found to be in mothers with early onset of pregnancy\u003c/p\u003e\n\u003cp\u003eTable 2: Mean \u0026plusmn; SD of OGTT, IR and Lipid parameters age group wise among \u0026nbsp;the pregnant mothers\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e\u003cstrong\u003eOGTT\u0026nbsp;\u003c/strong\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eIR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTC \u0026nbsp;\u003c/strong\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTG \u0026nbsp;\u003c/strong\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e\u003cstrong\u003eHDL\u0026nbsp;\u003c/strong\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLDL\u0026nbsp;\u003c/strong\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVLDL\u0026nbsp;\u003c/strong\u003e(mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e\u0026le;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e121\u0026plusmn;29.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.72\u0026plusmn;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e280.5\u0026plusmn;14.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e262.5\u0026plusmn;17.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e56\u0026plusmn;5.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\"\u003e\n \u003cp\u003e156\u0026plusmn;15.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e52.5\u0026plusmn;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e108.31\u0026plusmn;16.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.02\u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e165.06\u0026plusmn;38.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e139.34\u0026plusmn;62.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e47.87\u0026plusmn;14.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\"\u003e\n \u003cp\u003e96.87\u0026plusmn;24.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e27.86\u0026plusmn;12.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"8.421052631578947%\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.631578947368421%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e121.33\u0026plusmn;43.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.65\u0026plusmn;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e170.83\u0026plusmn;30.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.68421052631579%\"\u003e\n \u003cp\u003e214.66\u0026plusmn;91.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e48\u0026plusmn;16.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.578947368421053%\"\u003e\n \u003cp\u003e100.66\u0026plusmn;20.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.736842105263158%\"\u003e\n \u003cp\u003e42.93\u0026plusmn;18.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIt has been seen that there is significant difference among the mean values of OGTT, IR , TC, TG, VLDL among the GDM mothers as compared to mothers without GDM as shown in the table 3 below\u003c/p\u003e\n\u003cp\u003eTable -3 : Mean \u0026plusmn; SD of glycemic and lipid parameters among the GDM and Non GDM mothers\u003c/p\u003e\n\u003cdiv align=\"Left\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003eWithout GDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eWith GDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eOGTT (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e106.48 \u0026plusmn; 14.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e202 \u0026plusmn; 65.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e1.87 \u0026plusmn; 0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e3.39 \u0026plusmn; 1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eTC (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e148.33 \u0026plusmn; 27.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e173.59 \u0026plusmn; 45.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eTG (mg/dl)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e82.33 \u0026plusmn; 48.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e162.88 \u0026plusmn; 73.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eHDL (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e48.26 \u0026plusmn; 14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e45.11 \u0026plusmn; 7.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eLDL (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e83.33 \u0026plusmn; 15.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e101.78 \u0026plusmn; 26.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.163\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003eVLDL (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.16891891891892%\"\u003e\n \u003cp\u003e16.46 \u0026plusmn; 9.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25%\"\u003e\n \u003cp\u003e32.56 \u0026plusmn; 14.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.83108108108108%\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTable 4- Correlation and significance of \u0026nbsp;OGTT with IR and lipid parameters\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.94701986754967%\" colspan=\"2\"\u003e\n \u003cp\u003eOGTT\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.42857142857143%\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.57142857142857%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\"\u003e\n \u003cp\u003eIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.801324503311257%\"\u003e\n \u003cp\u003e0.4659\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.14569536423841%\"\u003e\n \u003cp\u003e0.0024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.801324503311257%\"\u003e\n \u003cp\u003e0.0189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.14569536423841%\"\u003e\n \u003cp\u003e0.9077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.801324503311257%\"\u003e\n \u003cp\u003e-0.0037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.14569536423841%\"\u003e\n \u003cp\u003e0.9814\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults of the correlation indicated that there is a significant medium positive relationship between OGTT and IR where (r = 0.4659, p = 0.0024). Also there is a non significant very small positive relationship between OGTT and TC where (r = 0.0189, p = 0.9077). Also there is a non significant very small negative relationship between OGTT and LDL where (r = -0.0037, p = 0.9814) as shown in table 4 (fig-1)\u003c/p\u003e\n\u003cp\u003eTable 5- Correlation and significance of \u0026nbsp;TC with IR and LDL in GDM mothers\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.94701986754967%\" colspan=\"2\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"51.42857142857143%\"\u003e\n \u003cp\u003ePearson Correlation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"48.57142857142857%\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\"\u003e\n \u003cp\u003eIR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.801324503311257%\"\u003e\n \u003cp\u003e0.2562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.14569536423841%\"\u003e\n \u003cp\u003e0.1106\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.05298013245033%\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.801324503311257%\"\u003e\n \u003cp\u003e0.8699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.14569536423841%\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eResults of the correlation indicated that there is a non significant small positive relationship between TC and IR where (r = 0.2562, p = 0.1106), and a significant large positive relationship between TC and LDL where \u0026nbsp;(r = 0.8699, p \u0026lt; 0.001) as shown in table 5 (fig-2)\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis research involved 1040 pregnant women of age group 18\u0026ndash;40. This finding indicate that insulin resistance is more prevalent in pregnant women of age group 31\u0026ndash;40. Furthermore, maximum GDM mothers were found majorly in this age group. Analyzing the lipid profile of these same cases, it is observed that lipid parameters like TC, TG, VLDL are significantly raised in the GDM mothers and also insulin resistance is also significantly raised .\u003c/p\u003e \u003cp\u003eThe connections between OGTT and insulin resistance have been examined in previous studies as suggested by (Ranganath Muniyappa et al. 2021).\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e This study involves assessing insulin sensitivity in humans and it showed that indices derived from OGTT are accurate in predicting insulin resistance. The correlation analysis revealed a significant medium positive relationship between OGTT and IR (\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.4659, p\u0026thinsp;=\u0026thinsp;0.0024\u003c/b\u003e). This suggests that as OGTT level increases IR also tend to increase.\u003c/p\u003e \u003cp\u003eThe correlation between TC and OGTT indicates that there is a non significant very small positive relationship between these two parameters (\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.0189, p\u0026thinsp;=\u0026thinsp;0.9077\u003c/b\u003e) aligning with the previous studies (F A Rahnemaei et al. 2021)\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, (Zhang et al. 2022) \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. It indicates that higher TC levels are linked to higher OGTT levels. The decreased concentration of TC, during OGTT, was related to an increased risk of postpartum abnormal glucose regulation in GDM women.\u003c/p\u003e \u003cp\u003eThe concentration of LDL is increased in pregnancy along with TC and TG due to the elevation in maternal estrogen level. LDL cholesterol constitutes a significant portion of total cholesterol and high levels of TC often reflect elevated LDL levels. This strong correlation underlies the use of both TC and LDL as key markers in cardiovascular risk assessment and guides clinical decisions in lipid management. \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e Results of the correlation indicated that there is a significant large positive relationship between TC and LDL (\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.8699\u003c/b\u003e, \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/b\u003e) (Mikael Huhtala et al. 2023).\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e Impaired glucose tolerance, identified by OGTT, often leads to higher LDL cholesterol levels due to insulin resistance. This condition increases cardiovascular risk. Early detection through OGTT can guide interventions to improve insulin sensitivity and lower LDL cholesterol. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e Results of the correlation indicated that there is a non significant very small negative relationship between OGTT and LDL. (\u003cb\u003er = -0.0037\u003c/b\u003e, \u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.9814\u003c/b\u003e), indicating that as OGTT levels increases there might be a decrease in LDL level. Conversely the studies of F A Rahnemaei et al. 2021 \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e shows contradicting results.\u003c/p\u003e \u003cp\u003eThe TG/HDL has been advocated as a simple clinical indicator of insulin resistance as studies done by Jui Kun Chiang et al 2011. \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e Insulin resistance is linked to higher total cholesterol, LDL cholesterol, and triglycerides, along with lower HDL cholesterol. Results of the correlation indicated that there is a non significant small positive relationship between TC and IR, (\u003cb\u003er\u0026thinsp;=\u0026thinsp;0.2562, p\u0026thinsp;=\u0026thinsp;0.1106\u003c/b\u003e) with increase in level of TC, the level of IR tend to increase slightly. Similar results are unveiled in the studies of F A Rahnemaei et al. 2021.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Moreover it has been found that as maternal age increases the risk of GDM also increases as also found by Yu-Jin Koo et al 2012 .\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e With insulin resistance, the body's cells don't respond normally to insulin. Glucose can't enter the cells as easily, so it builds up in the blood. This can eventually lead to Type II diabetes mellitus. Though, increased insulin resistance is seen during the course of a healthy pregnancy.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e During the early stages of normal pregnancies, the pancreatic β-cells secrete more insulin, which slows the rise in plasma glucose levels. This regulation explains the abnormally modest increases in plasma glucose levels brought on by elevated insulin resistance. IR is a state in which normal concentrations of insulin cannot elicit a response of target cells, and the negative feedback urges the body to secrete excess insulin. When insulin secretion fails to compensate for IR, Gestational Diabetes Mellitus emerges. Physiological IR during pregnancy is beneficial to fetal growth and can effectively supply nutrients but the degree of IR if significantly higher than that of normal pregnancy, which will cause many adverse effects on mother and fetus, such as preterm delivery, cesarean, macrosomia.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e Individuals with GDM are more likely to acquire chronic insulin resistance because of the superimposition of lower insulin production by the cells in that condition (GDM) (Irfat Ara et al. 2022). \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe correlation between lipid parameters (TC, TG, HDL-C, LDL-C, VLDL) and IR, OGTT results, and GDM can vary. A positive correlation between total cholesterol, and insulin resistance shows that as cholesterol levels rise, insulin resistance also increases, elevating the risk of GDM and cardiovascular diseases and metabolic syndrome. Also, a significant positive correlation between TC and LDL which indicates that high TC increases the risk of LDL. Thus, better glucose tolerance is associated with lower IR, TC, TG levels, suggesting improved metabolic health, a reduced risk of cardiovascular disease and healthier metabolic profiles with lower lipid levels. The principal results of this study indicates that pregnant women of advanced maternal age group 31\u0026ndash;40 years exhibits a higher incidence of gestational diabetes mellitus and insulin resistance.\u003c/p\u003e \u003cp\u003eThese correlations are crucial for understanding the metabolic health implications in pregnant women. It is concluded that due to alterations in lipid parameters, insulin resistance in pregnant women increases which causes a significant impact on Gestational Diabetes Mellitus.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eOn behalf of all authors, I hereby affirm that all authors have read the manuscript and agreed to its submission. We hereby certify that this manuscript consists of original and unpublished work which is not under consideration for publication elsewhere. Further, all authors declare that they do not have any conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSonagra AD, Biradar SM, K D, Murthy D S J. Normal pregnancy- a state of insulin resistance. J Clin Diagn Res. 2014 Nov;8(11):CC01-3. doi: 10.7860/JCDR/2014/10068.5081. Epub 2014 Nov 20. 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Use of metabolic markers to identify overweight individuals who are insulin resistant.\u0026nbsp;Ann Intern Med.\u0026nbsp;139, 802\u0026ndash;809 (2003).\u003c/li\u003e\n \u003cli\u003eIwani, N., Jalaludin, M., Zin, R. et al. Triglyceride to HDL-C Ratio is Associated with Insulin Resistance in Overweight and Obese Children. Sci Rep 7, 40055 (2017).\u0026nbsp;\u003ca href=\"https://doi.org/10.1038/srep40055\"\u003ehttps://doi.org/10.1038/srep40055\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Muniyappa R, Madan R, Varghese RT. Assessing Insulin Sensitivity and Resistance in Humans. [Updated 2021 Aug 9]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278954/\u003c/li\u003e\n \u003cli\u003eRahnemaei FA, Pakzad R, Amirian A, Pakzad I, Abdi F. Effect of gestational diabetes mellitus on lipid profile: A systematic review and meta-analysis. Open Med (Wars). 2021 Dec 15;17(1):70-86. doi: 10.1515/med-2021-0408. PMID: 34993347; PMCID: PMC8678474.\u003c/li\u003e\n \u003cli\u003eXie W, Wang Y, Xiao S, Qiu L, Yu Y, Zhang Z. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. bmj. 2022 Sep 21;378.\u003c/li\u003e\n \u003cli\u003eKannan, S., Mahadevan, S., Ramji, B., Jayapaul, M., \u0026amp; Kumaravel, V. (2014). LDL-cholesterol: Friedewald calculated versus direct measurement-study from a large Indian laboratory database. Indian Journal of Endocrinology and Metabolism, 18(4), 502. https://doi.org/10.4103/2230-8210.137496\u003c/li\u003e\n \u003cli\u003eHuhtala M, R\u0026ouml;nnemaa T, Tertti K. Insulin resistance is associated with an unfavorable serum lipoprotein lipid profile in women with newly diagnosed gestational diabetes. Biomolecules. 2023 Mar 3;13(3):470.\u003c/li\u003e\n \u003cli\u003eDannecker, C., Wagner, R., Peter, A., Hummel, J., Vosseler, A., H\u0026auml;ring, H. U., Fritsche, A., Birkenfeld, A. L., Stefan, N., \u0026amp; Heni, M. (2021). Low-Density Lipoprotein Cholesterol Is Associated With Insulin Secretion. \u0026tilde;the \u0026oelig;Journal of Clinical Endocrinology and Metabolism/Journal of Clinical Endocrinology \u0026amp; Metabolism, 106(6), 1576\u0026ndash;1584. https://doi.org/10.1210/clinem/dgab147\u003c/li\u003e\n \u003cli\u003eChiang, J. K., Lai, N. S., Chang, J. K., \u0026amp; Koo, M. (2011). Predicting insulin resistance using the triglyceride-to-high-density lipoprotein cholesterol ratio in Taiwanese adults. Cardiovascular Diabetology, 10(1). https://doi.org/10.1186/1475-2840\u003c/li\u003e\n \u003cli\u003eKoo YJ, Ryu HM, Yang JH, Lim JH, Lee JE, Kim MY, Chung JH. Pregnancy outcomes according to increasing maternal age. Taiwanese Journal of Obstetrics and Gynecology. 2012 Mar 1;51(1):60-5.\u003c/li\u003e\n \u003cli\u003eMotevalizadeh E, D\u0026iacute;az-L\u0026oacute;pez A, Mart\u0026iacute;n F, Basora J, Arija V. Association of parity with insulin resistance early in pregnant women: ECLIPSES study. The Journal of Clinical Endocrinology \u0026amp; Metabolism. 2024 Mar;109(3):730-9.\u003c/li\u003e\n \u003cli\u003eSonagra AD, Biradar SM, K D, Murthy D S J. Normal pregnancy- a state of insulin resistance. J Clin Diagn Res. 2014 Nov;8(11):CC01-3. doi: 10.7860/JCDR/2014/10068.5081. Epub 2014 Nov 20. PMID: 25584208; PMCID: PMC4290225.\u003c/li\u003e\n \u003cli\u003eAra I, Maqbool M, Gani I. Role of insulin resistance in gestational diabetes mellitus: a literature review. Chettinad Health City Medical Journal (E-2278-2044 \u0026amp; P-2277-8845). 2022 Jun 30;11(2):69-74..\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Gestational Diabetes Mellitus (GDM), Insulin Resistance (IR), Total Cholesterol (TC), Triglycerides (TG), Low-density lipoprotein (LDL), High-density lipoprotein (HDL), Very Low-density lipoprotein (VLDL).","lastPublishedDoi":"10.21203/rs.3.rs-4742399/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4742399/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e- Pregnancy triggers numerous changes in metabolism, biochemistry, physiology, hematology, and immunity. Healthy pregnant women may develop resistance to insulin's effects on glucose absorption and utilization. The TG/HDL has been advocated as a simple clinical indicator of insulin resistance. The relationship between lipid profiles, insulin resistance and gestational diabetes mellitus (GDM) remains controversial.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e- This research seeks to investigate the relationship between the ratio of Triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) as a marker for Insulin resistance and the association of IR and GDM in pregnancy.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and methods\u003c/strong\u003e- The study included 1040 pregnant mothers selected randomly attending for routine antenatal checkup. The study participants were in the age group of 18-40 years. OGTT is performed in pregnant women by measuring the plasma glucose after 2 hours of fasting or non-fasting after ingesting 75 grams of glucose. A single value of ≥140 mg/dl is diagnostic for Gestational Diabetes Mellitus according to Technical and operational guidelines of diagnosis and management of GDM by MOHFW, Govt of India. Lipid parameters and IR was also looked for.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e- OGTT, IR, TC, TG, VLDL was found to be significantly elevated among GDM mothers. GDM and IR was found to increase as maternal age increases. OGTT has been found to be significantly positively correlated to IR. Also TC was found to be significantly correlated to LDL.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e- \u0026nbsp;A positive correlation between total cholesterol, and insulin resistance shows that as cholesterol levels rise, insulin resistance also increases, elevating the risk of GDM. These correlations are crucial for understanding the metabolic health implications in pregnant women. It is concluded that due to alterations in lipid parameters, insulin resistance in pregnant women increases which causes a significant impact on Gestational Diabetes Mellitus.\u003c/p\u003e","manuscriptTitle":"Insulin Resistance and Gestational Diabetes Mellitus in Pregnancy – a Tertiary Care Hospital Based Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 15:49:38","doi":"10.21203/rs.3.rs-4742399/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1489bd35-3f6b-4b65-a787-cad86dacd120","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-18T15:49:38+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-18 15:49:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4742399","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4742399","identity":"rs-4742399","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}