Skip to main content
SpringerLink
Log in

Second Trimester Insulin Resistance, Early Pregnancy Body Mass Index and Gestational Weight Gain

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives Because prior work suggests an association between high insulin concentrations in early pregnancy and excess gestational weight gain, we examined such associations in a prospective cohort. Methods Multivariate regression analysis of early pregnancy insulin homeostasis and gestational weight gain among 434 women enrolled in the MGH Obstetrical Maternal Study. Results We found that the association between insulin quartile and gestational weight gain varied depending on maternal body mass index (BMI) in early pregnancy (P for interaction <0.0001). Among women with a BMI of 20, high fasting insulin was associated with greater gestational weight gain (multivariate-adjusted predicted mean 39.6, 95% CI 30.9–40.3 lbs for Quartile 4 (Q4) vs. 31.3, 95% CI 28.6–34.1 lbs for Q1) and higher risk of excessive weight gain. By contrast, among women with a BMI of 35, higher fasting insulin was associated with lower total gain (multivariate-adjusted predicted mean 25.7, 95% CI 22.6–28.7 lbs for Q4 vs. 33.2, 95% CI 10.5–55.9 lbs for Q1) and lower risk of excessive gain. Conclusion In our cohort, early pregnancy BMI modified the association between insulin homeostasis and gestational weight gain. These associations suggest that the physiologic consequences of hyperinsulinemia differ between normal weight and obese women.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Institute of Medicine. (1990). Nutrition during pregnancy. Washington, DC: National Academies Press.

    Google Scholar 

  2. Ehrenberg, H., et al. (2003). Low maternal weight, failure to thrive in pregnancy, and adverse pregnancy outcomes. American Journal of Obstetrics and Gynecology, 189(6), 1726–1730. doi:10.1016/S0002-9378(03)00860-3.

    Article  PubMed  Google Scholar 

  3. Schieve, L., et al. (2000). Prepregnancy body mass index and pregnancy weight gain: Associations with preterm delivery. The NMIHS Collaborative Study Group. Obstetrics and Gynecology, 96(2), 194–200. doi:10.1016/S0029-7844(00)00883-8.

    Article  CAS  PubMed  Google Scholar 

  4. Viswanathan, M., et al. (2008). Outcomes of maternal weight gain. Evidence Report/technology Assessment, 168, 1–223.

    PubMed  Google Scholar 

  5. National Research Council and Institute of Medicine. (2007). Influence of pregnancy weight on maternal and child health. Workshop Report. Washington, DC: The National Academies Press.

    Google Scholar 

  6. Guelinckx, I., et al. (2008). Maternal obesity: Pregnancy complications, gestational weight gain and nutrition. Obesity Reviews, 9(2), 140–150. doi:10.1111/j.1467-789X.2007.00464.x.

    Article  CAS  PubMed  Google Scholar 

  7. Stotland, N. E., Hopkins, L. M., & Caughey, A. B. (2004). Gestational weight gain, macrosomia, and risk of cesarean birth in nondiabetic nulliparas. Obstetrics and Gynecology, 104(4), 671–677.

    PubMed  Google Scholar 

  8. Bianco, A. T., et al. (1998). Pregnancy outcome and weight gain recommendations for the morbidly obese woman. Obstetrics and Gynecology, 91(1), 97–102. doi:10.1016/S0029-7844(97)00578-4.

    Article  CAS  PubMed  Google Scholar 

  9. Rosenberg, T. J., et al. (2005). Maternal obesity as diabetes as risk factors for adverse pregnancy outcomes: Differences among 4 racial/ethnic groups. American Journal of Public Health, 95(9), 1544–1661. doi:10.2105/AJPH.2005.065680.

    Article  Google Scholar 

  10. Juhasz, G., et al. (2005). Effect of body mass index and excessive weight gain on success of vaginal birth after cesarean delivery. Obstetrics and Gynecology, 106(4), 741–746.

    PubMed  Google Scholar 

  11. Rooney, B., & Schauberger, C. (2002). Excess pregnancy weight gain and long-term obesity: One decade later. Obstetrics and Gynecology, 100(2), 245–252. doi:10.1016/S0029-7844(02)02125-7.

    Article  PubMed  Google Scholar 

  12. Rooney, B. L., Schauberger, C. W., & Mathiason, M. A. (2005). Impact of perinatal weight change on long-term obesity and obesity-related illnesses. Obstetrics and Gynecology, 106(6), 1349–1356.

    PubMed  Google Scholar 

  13. Schieve, L. A., Cogswell, M. E., & Scanlon, K. S. (1999). Maternal weight gain and preterm delivery: Differential effects by body mass index. Epidemiology (Cambridge, Mass.), 10(2), 141–147. doi:10.1097/00001648-199903000-00010.

    CAS  Google Scholar 

  14. Edwards, L. E., et al. (1996). Pregnancy complications and birth outcomes in obese and normal-weight women: Effects of gestational weight change. Obstetrics and Gynecology, 87(3), 389–394. doi:10.1016/0029-7844(95)00446-7.

    Article  CAS  PubMed  Google Scholar 

  15. Sewell, M. F., et al. (2006). Increased neonatal fat mass, not lean body mass, is associated with maternal obesity. American Journal of Obstetrics and Gynecology, 195(4), 1100–1103. doi:10.1016/j.ajog.2006.06.014.

    Article  PubMed  Google Scholar 

  16. Oken, E., et al. (2007). Gestational weight gain and child adiposity at age 3 years. American Journal of Obstetrics and Gynecology, 196(4), 322 e1–322 e8.

    Article  Google Scholar 

  17. Oken, E., et al. (2008). Maternal gestational weight gain and offspring weight in adolescence. Obstetrics and Gynecology, 112(5), 999–1006.

    PubMed  Google Scholar 

  18. Stuebe, A. M., & Michels, K. B. (2006). Gestational weight gain and obesity at age 18 in the daughter. American Journal of Obstetrics and Gynecology, 195(6), S228.

    Google Scholar 

  19. Scholl, T., & Chen, X. (2002). Insulin and the “thrifty” woman: The influence of insulin during pregnancy on gestational weight gain and postpartum weight retention. Maternal and Child Health Journal, 6(4), 255–261. doi:10.1023/A:1021162117177.

    Article  PubMed  Google Scholar 

  20. Thadhani, R., et al. (2003). First-trimester sex hormone binding globulin and subsequent gestational diabetes mellitus. American Journal of Obstetrics and Gynecology, 189(1), 171–176. doi:10.1067/mob.2003.343.

    Article  CAS  PubMed  Google Scholar 

  21. Wolf, M., et al. (2002). Insulin resistance but not inflammation is associated with gestational hypertension. Hypertension, 40(6), 886–891. doi:10.1161/01.HYP.0000042085.65467.9F.

    Article  CAS  PubMed  Google Scholar 

  22. Matthews, D. R., et al. (1985). Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 28(7), 412–419. doi:10.1007/BF00280883.

    Article  CAS  PubMed  Google Scholar 

  23. Schieve, L. A., Cogswell, M. E., & Scanlon, K. S. (1998). Trends in pregnancy weight gain within and outside ranges recommended by the Institute of Medicine in a WIC population. Maternal and Child Health Journal, 2(2), 111–116. doi:10.1023/A:1022992823185.

    Article  CAS  PubMed  Google Scholar 

  24. Stotland, N. E., et al. (2006). Gestational weight gain and adverse neonatal outcome among term infants. Obstetrics and Gynecology, 108(3), 635–643.

    PubMed  Google Scholar 

  25. Ebbeling, C. B., et al. (2007). Effects of a low-glycemic load vs low-fat diet in obese young adults: A randomized trial. Journal of the American Medical Association, 297(19), 2092–2102. doi:10.1001/jama.297.19.2092.

    Article  CAS  PubMed  Google Scholar 

  26. Schwartz, M. W., & Niswender, K. D. (2004). Adiposity signaling and biological defense against weight gain: Absence of protection or central hormone resistance? The Journal of Clinical Endocrinology and Metabolism, 89(12), 5889–5897. doi:10.1210/jc.2004-0906.

    Article  CAS  PubMed  Google Scholar 

  27. Swinburn, B. A., et al. (1991). Insulin resistance associated with lower rates of weight gain in Pima Indians. The Journal of Clinical Investigation, 88(1), 168–173. doi:10.1172/JCI115274.

    Article  CAS  PubMed  Google Scholar 

  28. Hoag, S., et al. (1995). High fasting insulin levels associated with lower rates of weight gain in persons with normal glucose tolerance: the San Luis Valley Diabetes Study. International Journal of Obesity and Related Metabolic Disorders, 19(3), 175–180.

    CAS  PubMed  Google Scholar 

  29. Tremblay, A., et al. (2005). Is the insulin resistance syndrome the price to be paid to achieve body weight stability? International Journal of Obesity, 29(10), 1295–1298. doi:10.1038/sj.ijo.0803019.

    Article  CAS  PubMed  Google Scholar 

  30. Guilherme, A., et al. (2008). Adipocyte dysfunctions linking obesity to insulin resistance and type 2 diabetes. Nature Reviews. Molecular Cell Biology, 9(5), 367–377. doi:10.1038/nrm2391.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Preliminary results were presented in part at the Society for Gynecologic Investigation, Reno, Nevada, March 17, 2007. This study was supported by Clinical Investigator Awards from the American Diabetes Association and The National Institutes of Health (HD39332).

Author information

Authors and Affiliations

  1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA, USA

    Alison M. Stuebe & Thomas F. McElrath

  2. Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Ravi Thadhani

  3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA

    Jeffrey L. Ecker

  4. Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 3010 Old Clinic Building, CB# 7516, Chapel Hill, NC, 27599-7516, USA

    Alison M. Stuebe

Authors
  1. Alison M. Stuebe
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas F. McElrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ravi Thadhani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jeffrey L. Ecker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alison M. Stuebe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stuebe, A.M., McElrath, T.F., Thadhani, R. et al. Second Trimester Insulin Resistance, Early Pregnancy Body Mass Index and Gestational Weight Gain. Matern Child Health J 14, 254–260 (2010). https://doi.org/10.1007/s10995-009-0449-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-009-0449-2

Keywords

Search

Navigation