Early Pregnancy Insulin Resistance and Subsequent Gestational Diabetes Mellitus
- Karen V. Smirnakis, MD, PHD, MPH1,
- Abelardo Martinez, MD1,
- Karen Hsu Blatman, BA1,
- Myles Wolf, MS, MMSC1,
- Jeffrey L. Ecker, MD2 and
- Ravi Thadhani, MD, MPH12
- 1Renal Unit, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- 2Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Address correspondence and reprint requests to Karen V. Smirnakis, MD, PhD, MPH, GRB 1003, Renal Unit, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114. Email: ksmirnakis{at}partners.org
Gestational diabetes mellitus (GDM), which complicates 3–7% of all pregnancies, is associated with increased maternal and fetal morbidity (1). Identification of early risk markers may result in improved understanding of disease pathogenesis and identification of potential targets for intervention. We sought to determine the association between early pregnancy insulin resistance and subsequent abnormal glucose tolerance in pregnancy.
RESEARCH DESIGN AND METHODS
We conducted two institutional review board–approved, prospective, nested, case-control studies within Massachusetts General Hospital’s Obstetrical Maternal Study (MOMS) comparing subjects with GDM and subjects with abnormal glucose loading test (GLT) results but no GDM with control subjects. Consecutive MOMS participants with singleton gestations between February 2002 and February 2004 who provided fasting blood samples between 16–18 weeks’ gestation, underwent GLT testing at 24–28 weeks’ gestation, and delivered after 34 weeks were eligible. To limit confounding by other etiologies of insulin …
