Am J Perinatol 2016; 33(10): 983-990
DOI: 10.1055/s-0036-1583188
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Is Mid-trimester Insulin Resistance Predictive of Subsequent Puerperal Infection? A Secondary Analysis of Randomized Trial Data

Brenna L. Hughes
1   Department of Obstetrics and Gynecology, Women & Infants Hospital, Brown University, Providence, Rhode Island
,
Rebecca G. Clifton
2   The George Washington University Biostatistics Center, Washington, District of Columbia
,
John C. Hauth
3   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Kenneth J. Leveno
4   Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
,
Leslie Myatt
5   Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio
,
Uma M. Reddy
6   The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
,
Michael W. Varner
7   Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
,
Ronald J. Wapner
8   Department of Obstetrics and Gynecology, Columbia University, New York, New York
,
Brian M. Mercer
9   Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
,
Alan M. Peaceman
10   Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois
,
Susan M. Ramin
11   Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas
,
Jorge E. Tolosa
12   Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon
,
George Saade
13   Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas
,
Yoram Sorokin
14   Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan
,
for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network › Author Affiliations
Further Information

Publication History

01 December 2015

14 March 2016

Publication Date:
27 April 2016 (online)

Abstract

Objective The objective of this study was to examine whether there is an association between insulin resistance and subsequent development of puerperal infection by measuring insulin resistance in the mid-trimester using the homeostasis model assessment (HOMA:IR).

Methods Secondary analysis of low-risk nulliparas enrolled in a multicenter preeclampsia prevention trial. HOMA:IR was measured on fasting plasma glucose and insulin concentrations among low-risk nulliparas between 22 and 26 weeks' gestation. Median HOMA:IR was compared between women who did and did not develop puerperal infection using Wilcoxon rank sum test. Logistic regression was used to control for potential confounders.

Results Of 1,180 women with fasting glucose and insulin available, 121 (10.3%) had a puerperal infection. Median HOMA:IR was higher among those with subsequent puerperal infection (4.3 [interquartile, IQR: 2.2–20.5] vs. 2.6 [IQR: 1.5–6.7], p < 0.0001). After controlling for potentially confounding variables HOMA:IR was only marginally associated with an increased risk of development of puerperal infection, adjusted odds ratio: 1.01 (95% confidence interval: 1.00–1.02; p = 0.04) per unit increase. Elevated HOMA:IR performed poorly as a predictor of puerperal infection, with a positive predictive value of 15% and a negative predictive value of 92%.

Conclusion Though associated with an increased risk of puerperal infection, insulin resistance, measured by HOMA:IR, is not a clinically useful predictor of puerperal infection.

 
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