Effect of excessive gestational weight gain on insulin sensitivity and insulin kinetics in women with overweight/obesity

Abstract

Objective: Obesity increases the risk for pregnancy complications and maternal hyperglycemia. The Institute of Medicine developed guidelines for gestational weight gain (GWG) targets for women with overweight/obesity, but it is unclear whether exceeding these targets has adverse effects on maternal glucose metabolism.

Methods: Insulin sensitivity (assessed using the Matsuda Insulin Sensitivity Index), β-cell function (assessed as insulin secretion rate in relation to plasma glucose), and plasma insulin clearance rate were evaluated using a frequently sampled oral glucose tolerance test at 15 and 35 weeks of gestation in 184 socioeconomically disadvantaged African American women with overweight/obesity.

Results: Insulin sensitivity decreased, whereas β-cell function and insulin clearance increased from 15 to 35 weeks of gestation in the entire group. Compared with women who achieved the recommended GWG, excessive GWG was associated with a greater decrease in insulin sensitivity between 15 and 35 weeks. β-cell function and plasma insulin clearance were not affected by excessive GWG.

Conclusions: These data demonstrate that gaining more weight during pregnancy than recommended by the Institute of Medicine is associated with functional effects on glucose metabolism.

Trial registration: ClinicalTrials.gov NCT01768793.

Figure 1.

Metabolic profile during the oral glucose tolerance test in women who achieved and women who exceeded gestational weight gain recommendations. Panels A-D and F. Plasma glucose (A), insulin (B), and C-peptide (C) concentrations, insulin secretion rate (D), and plasma insulin clearance rate (F) immediately before and for two hours after ingesting 75 grams of glucose. Panel E. Insulin secretion rate in relation to plasma glucose concentration during the first 30 min of the oral glucose tolerance test. Values are mean ± SEM. Abbreviations: A, achieved; E, exceeded; GWG, gestational weight gain; ICR, insulin clearance rate; ISR, insulin secretion rate.

Figure 2.

Relationships between the pregnancy-induced change in insulin sensitivity and both gestational weight gain and baseline insulin sensitivity in women who achieved and women who exceeded gestational weight gain recommendations. Panel A. Relationship between the change in insulin sensitivity, assessed using the Matsuda Insulin Sensitivity Index, and the change in body weight between 15 weeks and 35 weeks of gestation. Panel B. Relationship between the change in insulin sensitivity, assessed using the Matsuda Insulin Sensitivity Index, between 15 weeks and 35 weeks of gestation and the corresponding index value at 15 weeks. Symbols represent individual participants’ data. Abbreviations: A, achieved; E, exceeded; GWG, gestational weight gain. The Pearson product moment coefficient (r-value) in Panel A refers to the entire cohort (all 184 participants) because the relationships were not different between the E-GWG and the A-GWG groups. The Pearson product moment coefficients (r-values) in Panel B refer to the E-GWG group (red font) and the A-GWG group (blue font), respectively.