Failure to increase insulin secretory capacity during pregnancy-induced insulin resistance is associated with ethnicity and gestational diabetes

Abstract

Objective: To assess changes in insulin resistance and b-cell function in a multiethnic cohort of women in Oslo, Norway, from early to 28 weeks' gestation and 3 months post partum and relate the findings to gestational diabetes mellitus (GDM). Method: Population-based cohort study of 695 healthy pregnant women from Western Europe (41%), South Asia (25%), Middle East (15%), East Asia (6%) and elsewhere (13%). Blood samples and demographics were recorded at mean 15 (V1) and 28 (V2) weeks' gestation and 3 months post partum (V3). Universal screening was by 75 g oral glucose tolerance test at V2, GDM with modified IADPSG criteria (no 1-h measurement): fasting plasma glucose (PG) R5.1 or 2-h PG R8.5 mmol/l. Homeostatic model assessment (HOMA)-b (b-cell function) and HOMA-IR (insulin resistance) were calculated from fasting glucose and C-peptide. Result: Characteristics were comparable across ethnic groups, except age (South Asians: younger, P!0.001) and prepregnant BMI (East Asians: lower, PZ0.040). East and South Asians were more insulin resistant than Western Europeans at V1. From V1 to V2, the increase in insulin resistance was similar across the ethnic groups, but the increase in b-cell function was significantly lower for the East and South Asians compared with Western Europeans. GDM women compared with non-GDM women were more insulin resistant at V1; from V1 to V2, their b-cell function increased significantly less and the percentage increase in b-cell function did not match the change in insulin resistance. Conclusion: Pregnant women from East Asia and South Asia were more insulin resistant and showed poorer HOMA-b-cell function than Western Europeans.

Prevalence and risk factors of gestational diabetes in Punjab, North India: results from a population screening program

“…Accordingly, the current study proved to be the most cost-effective among all of the included screening programs in a recent report (22,21). Furthermore, the overall attendance rate of 82% compared with 54% in the HAPO study (7) and 74% in a recent Norwegian GDM screening study (35) is high, and the results are therefore likely to be representative for the general population of Punjab. For reasons of convenience, we used capillary blood samples for the 2-h PG measurements, which due to the fluctuating plasma glucose levels after glucose ingestion exhibit a higher variability compared with fasting measurements obtained during steady state glucose levels.…”

The Association Between Physical Activity During Pregnancy and Gestational Diabetes Mellitus: A Case-Control Study

“…Moreover, in a study conducted by Morkrid et al, its reliability was confirmed by Cronbach’s alpha of 0.85% in Iran (22)…”

Impact of adopting the 2013 World Health Organization criteria for diagnosis of gestational diabetes in a multi-ethnic Asian cohort: a prospective study

“…These disparities and data from our study and others’ [27] support the notion of variation in glycaemic responses to a glucose load in pregnancy among different Asian ethnicities. Pregnant women from East Asia and South Asia have been found to be more insulin-resistant, with poorer homeostatic model assessment (HOMA) β-cell function, than Western Europeans [28], leading to different rates of GDM. Other contributory factors to the variations in the reported change in GDM rates include differences in the study setting (community vs. tertiary-care hospital) and type of screening approach (universal vs. risk-based and one-step vs. two-step screening).…”