title: Homeostatic indices of insulin resistance among gestational diabetics in anticipating pregnancy complications.
abstract: OBJECTIVE
  This was to determine HOMA-IR score as well as to assess its association in fetal and maternal outcomes among pregnant women with diabetes risks.
  
  
  METHODS
  A prospective cohort study of pregnant women with diabetes risks was done. GDM was diagnosed using modified glucose tolerance test. Serum insulin was taken and measured by an electrochemiluminescence immunoassay method. Plasma glucose was measured by enzymatic reference method with hexokinase. HOMA-IR score was calculated for each patient. Maternal and fetal outcomes were analyzed.
  
  
  RESULTS
  From 279 women recruited, 22.6% had GDM with higher HOMA-IR score (4.07 ± 2.44 versus 2.08 ± 1.12; p = 0.001) and fasting insulin (16.76 ± 8.63 µIU/L versus 10.15 ± 5.07 µIU/L; p = 0.001). Area under ROC curve for HOMA-IR score was 0.79 (95% confidence interval, 0.74-0.84) with optimum cut-off value of 2.92 (sensitivity = 63.5%; specificity = 89.8%), higher than recommended by IDF (2.38). This point showed significant association with neonatal hypoglycemia (p = 0.02) and Cesarean section (p = 0.04) in GDM mothers.
  
  
  CONCLUSIONS
  HOMA-IR score and insulin resistance levels were higher in GDM women in our population. With the cut-off HOMA-IR value of 2.92, neonatal hypoglycemia and Cesarean section were significant complications in GDM mothers. This can be used in anticipation of maternal and fetal morbidities.
authors.affiliation: Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. azlinm@ppukm.ukm.edu.my
authors.forename: Nor Azlin Mohamed
authors.initials: NA
authors.lastname: Ismail
authors.forename: Maslinda Mohd
authors.initials: MM
authors.lastname: Kasim
authors.forename: Azimatun
authors.initials: A
authors.lastname: Noor Aizuddin
authors.forename: Nor Aini
authors.initials: NA
authors.lastname: Umar
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D006305:Health Status Indicators; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011379:Prognosis; D012680:Sensitivity and Specificity