Associations Between Insulin Resistance and Adverse Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: a Retrospective Study

Background: This study aimed to explore the relationship between insulin resistance (IR) and adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM), and to determine the risk factors for IR in women with GDM. Methods: : This study employed a retrospective survey of 710 women diagnosed with GDM. Serum lipids, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), and serum protein were measured in the first trimester (6-12 weeks), and OGTT and fasting insulin tests were performed in the second trimester (24-28 weeks). These results were then used to evaluate IR by homeostasis model assessment (HOMA). When HOMA-IR≥2.0, IR was diagnosed. The relationship between HOMA-IR and adverse pregnancy outcomes was analyzed by a logistic regression model, and multiple stepwise regression was used to analyze the risk factors of HOMA-IR. Results: : GDM with IR was significantly associated with the hypertensive disorders of pregnancy and large for gestational age (LGA) ( P =0.002, 0.012, respectively). Body mass index (BMI) before pregnancy, FPG, HbA1c, and total triglyceride (TG) in early pregnancy were all significantly positively correlated with IR in the second trimester ( P <0.05), while age was significantly negatively correlated with IR ( P <0.001). Conclusion: GDM combined with IR in the second trimester increases adverse pregnancy outcomes, especially the risk of hypertensive disorders of pregnancy and LGA. In addition, BMI before pregnancy, FPG, HbA1c, and TG in early pregnancy are all independent risk factors for IR.