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Objective: Macrosomia is associated with increased maternal and fetal complications in obstetric practice. Gestational diabetes mellitus (GDM), maternal obesity, insulin resistance (IR), and other variables such as maternal age and gestational age at delivery may influence neonatal birth weight. It is not clear if a severe degree of IR in pregnancy is an independent risk factor for macrosomia. We therefore investigated the association between IR and macrosomia independent of GDM and other confounding factors. Materials and Methods: We measured the insulin sensitivity index (Matsuda index) in 118 pregnant women during a 75-g oral glucose tolerance test at 24-32 weeks of gestation. The birth weights of their neonates were measured at delivery. Multiple logistic regression was use to assess the association between IR and macrosomia after controlling for confounders GDM and other confounding factors. Results: Twenty-four women (20.3%) were classified under IR, 20 women (16.9%) and 62 women (52.5%) had GDM and obesity, respectively. Eleven women (9.3%) had macrosomic babies. Although the fasting insulin and 2-h insulin were higher in women with macrosomic babies compared to the normal weight babies, the observed difference was not significant (P > 0.05). The Matsuda index was significantly lower among women with macrosomic babies. Severe IR (odds ratio OR 95% confidence interval (CI) = 9.3 2.4-35.1) and GDM (OR 95% CI = 12.7 3.3-49.2) were significantly associated with macrosomia. After adjusting for the confounding variables, IR remained significantly associated with macrosomia (adjusted OR 95% CI = 10.0 1.6-64.4). Conclusion: IR is an independent risk factor for macrosomia, and its assessment during pregnancy should form a basis for categorizing women at risk of macrosomia.
Imoh et al. (Fri,) studied this question.