Relationship Between Insulin Resistance And High-risk Factors Associated Cardiovascular Diseases In Gestational Diabetes Mellitus

Objective To determine the quantitative dependent relationship between insulin resistance (IR), leptin and cardiovascular risk factors in gestational diabetes mellitus (GDM), and to look for the special predictor for evaluating the risk of cardiovascular disease(CVD) in GDM, which might provide some theoretical evidences for clinical interventions.Methods In a prospective study, a 2-h 75g oral glucose tolerance test was performed in 283 pregnant women in antenatal care at 28-30 weeks of gestation. The GDM group diagnosesed according to WHO criteria was compared with control group matched for age (眑yr), exact parity, race, gravity, and gestational weeks (眑wk). The differences of body mass index (BMI), waist/hip ratio (WHR), blood pressure (BP), OGTT fasting and 2-h plasma glucose, TC, TG, HDL-C, LDL-C, fasting insulin (FINS), leptin levels and insulin resistance index (HOMA-IR) between the two groups were evaluated and the relationship between HOMA-IR, leptin and cardiovascular risk factors were analysed.Results 1. 40 cases diagnosesed as GDM from the 283 women were compared with the control group(l:2), there was no difference in BP during pregnancy and leptin level in two groups. BMI at booking, WHR at OGTT, OGTT results, TG, LDL-C, FINS and HOMA-IR were significantly higher, and weight gain through pregnancy, HDL-C were significantly lower in GDM group than those in control group. 2. GDM patients had a higher frequency of cardiovascular risk factors clustering. 3.By univariate analyses, HOMA-IR was found to be related with weight, WHR, SBP, MAP, TG, HDL-C, and leptin level statistically. However, when forward step-wise linear regression analysis was used, only BMI, TG, LDL-C levels wereproved as independent predictors of HOMA-IR. In the same way, only BMI was independently associated with leptin. 4.The results of non-conditional univariate and multivariate stepwise Logistic regression indicated that the HOMA-IR associated with cardiovascular high-risk factors clustering regardless of leptin and WHR.Conclusions 1 .The risk for CVD in GDM was higher than in normal pregnant women. 2. IR was involved with regulation of glucose and lipid metabolism, and HOMA-IR was the independent predictors of cardiovascular high-risk factors clustering in GDM. 4. There was relationship between leptin and maternal weight change during pregnancy as well as body mass index, but the relationship between leptin and glucose and lipid metabolism were rather weak. Leptin was not a specific marker to monitor the risk of CVD in GDM.