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Am J Perinatol 2016; 33(01): 114-122
DOI: 10.1055/s-0035-1562928
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Relationship of Early Pregnancy Waist-to-Hip Ratio versus Body Mass Index with Gestational Diabetes Mellitus and Insulin Resistance

Authors

  • Sanmaan K. Basraon

    1   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

  • Lisa Mele

    2   Biostatistics Center, George Washington University, Washington, District of Columbia

  • Leslie Myatt

    3   University of Cincinnati, Cincinnati, Ohio

  • James M. Roberts

    4   University of Pittsburgh, Pittsburgh, Pennsylvania

  • John C. Hauth

    5   University of Alabama at Birmingham, Birmingham, Alabama

  • Kenneth J. Leveno

    6   University of Texas Southwestern Medical Center, Dallas, Texas

  • Michael W. Varner

    7   University of Utah Health Sciences Center, Salt Lake City, Utah

  • Ronald J. Wapner

    8   Columbia University, New York, New York

  • John M. Thorp Jr

    9   University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

  • Alan M. Peaceman

    10   Northwestern University, Chicago, Illinois

  • Susan M. Ramin

    11   University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas

  • Anthony Sciscione

    12   Drexel University, Philadelphia, Pennsylvania

  • Jorge E. Tolosa

    13   Oregon Health & Science University, Portland, Oregon

  • Yoram Sorokin

    14   Wayne State University, Detroit, Michigan
    • for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network
Further Information

Publication History

07 January 2015

07 July 2015

Publication Date:
09 September 2015 (online)

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Abstract

Objective To determine the risk of gestational diabetes mellitus (GDM) and insulin resistance (IR) in obesity defined by body mass index (BMI), waist-to-hip ratio (WHR), or both combined.

Methods Secondary analysis of a randomized multicenter trial of antioxidant supplementation versus placebo in nulliparous low-risk women to prevent pregnancy associated hypertension. Women between 9 and 16 weeks with data for WHR and BMI were analyzed for GDM (n = 2,300). Those with fasting glucose and insulin between 22 and 26 weeks (n = 717) were analyzed for IR by homeostatic model assessment of IR (normal, ≤ 75th percentile). WHR and BMI were categorized as normal (WHR, < 0.80; BMI, < 25 kg/m2); overweight (WHR, 0.8–0.84; BMI, 25–29.9 kg/m2); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m2). Receiver operating characteristic curves and logistic regression models were used.

Results Compared with normal, the risks of GDM or IR were higher in obese by BMI or WHR. The subgroup with obesity by WHR but not by BMI had no increased risk of GDM. BMI was a better predictor of IR (area under the curve [AUC]: 0.71 [BMI], 0.65 [WHR], p = 0.03) but similar to WHR for GDM (AUC: 0.68 [BMI], 0.63 [WHR], p = 0.18).

Conclusion Increased WHR and BMI in early pregnancy are associated with IR and GDM. BMI is a better predictor of IR compared with WHR. Adding WHR to BMI does not improve its ability to detect GDM or IR.

Keywords

maternal BMI - waist-to-hip ratio - gestational diabetes mellitus - insulin resistance

Note

Trial Registration number: NCT00135707. Available at: http://clinicaltrials.gov/.