Randomized Controlled Trial

. 2016 Jan;33(1):114-21.

doi: 10.1055/s-0035-1562928. Epub 2015 Sep 9.

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

Sanmaan K Basraon¹, Lisa Mele², Leslie Myatt³, James M Roberts⁴, John C Hauth⁵, Kenneth J Leveno⁶, Michael W Varner⁷, Ronald J Wapner⁸, John M Thorp Jr⁹, Alan M Peaceman¹⁰, Susan M Ramin¹¹, Anthony Sciscione¹², Jorge E Tolosa¹³, Yoram Sorokin¹⁴; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network

Collaborators, Affiliations

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network:
G Saade, J Moss, B Stratton, G Hankins, J Brandon, C Nelson-Becker, G Olson, L Pacheco, S Caritis, T Kamon, M Cotroneo, D Fischer, P Reed, S Quinn, V Morby, F Porter, R Silver, J Miller, K Hill, D J Rouse, A Northen, P Files, J Grant, M Wallace, K Bailey, S Bousleiman, R Alcon, K Saravia, F Loffredo, A Bayless, C Perez, M Lake, M Talucci, K Boggess, K Dorman, J Mitchell, K Clark, S Timlin, B Mercer, J Bailit, C Milluzzi, W Dalton, C Brezine, D Bazzo, K J Sheffield, L Moseley, M Santillan, K Buentipo, J Price, L S Hermann, C Melton, Y Gloria-McCutchen, B Espino, M Dinsmoor, T Matson-Manning, G Mallett, S Blackwell, K Cannon, S Lege-Humbert, Z Spears, M Carpenter, J Tillinghast, M Seebeck, P Samuels, J Iams, F Johnson, S Fyffe, C Latimer, S Frantz, S Wylie, M Talucci, M Hoffman, J Benson, Z Reid, C Tocci, M Harper, P Meis, M Swain, W Smith, L Davis, E Lairson, S Butcher, S Maxwell, D Fisher, G Norman, S Blackwell, P Lockhart, D Driscoll, M Dombrowski, E Thom, R Clifton, T Boekhoudt, L Leuchtenburg, G Pearson, V Pemberton, J Cutler, W Barouch, C Spong, S Tolivaisa, G D Anderson

Affiliations

¹ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
² Biostatistics Center, George Washington University, Washington, District of Columbia.
³ University of Cincinnati, Cincinnati, Ohio.
⁴ University of Pittsburgh, Pittsburgh, Pennsylvania.
⁵ University of Alabama at Birmingham, Birmingham, Alabama.
⁶ University of Texas Southwestern Medical Center, Dallas, Texas.
⁷ University of Utah Health Sciences Center, Salt Lake City, Utah.
⁸ Columbia University, New York, New York.
⁹ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
¹⁰ Northwestern University, Chicago, Illinois.
¹¹ University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas.
¹² Drexel University, Philadelphia, Pennsylvania.
¹³ Oregon Health & Science University, Portland, Oregon.
¹⁴ Wayne State University, Detroit, Michigan.

PMID: 26352680
PMCID: PMC5283057
DOI: 10.1055/s-0035-1562928

Randomized Controlled Trial

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

Sanmaan K Basraon et al. Am J Perinatol. 2016 Jan.

. 2016 Jan;33(1):114-21.

doi: 10.1055/s-0035-1562928. Epub 2015 Sep 9.

Authors

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network:
G Saade, J Moss, B Stratton, G Hankins, J Brandon, C Nelson-Becker, G Olson, L Pacheco, S Caritis, T Kamon, M Cotroneo, D Fischer, P Reed, S Quinn, V Morby, F Porter, R Silver, J Miller, K Hill, D J Rouse, A Northen, P Files, J Grant, M Wallace, K Bailey, S Bousleiman, R Alcon, K Saravia, F Loffredo, A Bayless, C Perez, M Lake, M Talucci, K Boggess, K Dorman, J Mitchell, K Clark, S Timlin, B Mercer, J Bailit, C Milluzzi, W Dalton, C Brezine, D Bazzo, K J Sheffield, L Moseley, M Santillan, K Buentipo, J Price, L S Hermann, C Melton, Y Gloria-McCutchen, B Espino, M Dinsmoor, T Matson-Manning, G Mallett, S Blackwell, K Cannon, S Lege-Humbert, Z Spears, M Carpenter, J Tillinghast, M Seebeck, P Samuels, J Iams, F Johnson, S Fyffe, C Latimer, S Frantz, S Wylie, M Talucci, M Hoffman, J Benson, Z Reid, C Tocci, M Harper, P Meis, M Swain, W Smith, L Davis, E Lairson, S Butcher, S Maxwell, D Fisher, G Norman, S Blackwell, P Lockhart, D Driscoll, M Dombrowski, E Thom, R Clifton, T Boekhoudt, L Leuchtenburg, G Pearson, V Pemberton, J Cutler, W Barouch, C Spong, S Tolivaisa, G D Anderson

Affiliations

¹ Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.
² Biostatistics Center, George Washington University, Washington, District of Columbia.
³ University of Cincinnati, Cincinnati, Ohio.
⁴ University of Pittsburgh, Pittsburgh, Pennsylvania.
⁵ University of Alabama at Birmingham, Birmingham, Alabama.
⁶ University of Texas Southwestern Medical Center, Dallas, Texas.
⁷ University of Utah Health Sciences Center, Salt Lake City, Utah.
⁸ Columbia University, New York, New York.
⁹ University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
¹⁰ Northwestern University, Chicago, Illinois.
¹¹ University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas.
¹² Drexel University, Philadelphia, Pennsylvania.
¹³ Oregon Health & Science University, Portland, Oregon.
¹⁴ Wayne State University, Detroit, Michigan.

PMID: 26352680
PMCID: PMC5283057
DOI: 10.1055/s-0035-1562928

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/m(2)); overweight (WHR, 0.8-0.84; BMI, 25-29.9 kg/m(2)); and obese (WHR, ≥ 0.85; BMI ≥ 30 kg/m(2)). 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.

Trial registration: ClinicalTrials.gov NCT00135707.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Figures

**Figure 1**
Study participants analyzed for Gestational Diabetes Mellitus and Insulin Resistance

**Figure 2**
Percentage with GDM and IR by obesity category when BMI and WHR were combined. P-values presented pertain to adjusted odds ratios for GDM and IR from multivariable logistic regression analysis. The obesity category is compared with the reference category of non-obese (WHR<0.85 and BMI <30).

**Figure 3**
Receiver operating characteristics curves showing the association of WHR versus BMI with GDM (a) and HOMA-IR (b).

See this image and copyright information in PMC

References

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1. WHO. World Health Organization. WHO technical report series: 894; 2000. Obesity- Preventing and Managing the global epidemic: Report of a WHO consultation on Obesity. - PubMed
1. Carey DG, Jenkins AB, Campbell LV, Freund J, Chisholm DJ. Abdominal fat and insulin resistance in normal and overweight women: Direct measurements reveal a strong relationship in subjects at both low and high risk of NIDDM. Diabetes. 1996;45(5):633–638. - PubMed
1. Han TS, van Leer EM, Seidell JC, Lean ME. Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample. BMJ. 1995;311(7017):1401–1405. - PMC - PubMed
1. Dalton M, Cameron AJ, Zimmet PZ, Shaw JE, Jolley D, Dunstan DW, et al. Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults. Journal of internal medicine. 2003;254(6):555–563. - PubMed

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

Collaborators

Affiliations

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

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