Insulin Resistance and Homa-Ir Levels in Third-Trimester Normal Obese Pregnant Women: Synergistic Effects of Pregnancy and Obesity

Abstract

Hermanto Tri Joewono, Esmond W and Sonny W

Background: Normal pregnancy is characterized as a diabetogenic state marked by increased anabolism, accelerated starvation, and insulin resistance. Obesity is associated with low-grade inflammation and insulin resistance. The com- bination of these two conditions is considered synergistic, leading to increased insulin resistance. In recent years, a significant proportion of pregnant women have been classified as overweight or obese. HOMA-IR is one of the markers used to measure the level of insulin resistance. We aimed to assess the level of insulin resistance in third-trimester preg- nant women, both obese and nonobese.

Objective: To measure and correlate HOMA-IR levels in normal obese and nonobese third-trimester pregnant women.

Methods: This cross-sectional study involved 42 third-trimester pregnant women who visited the antenatal clinic at Dr. Soetomo General Hospital after obtaining ethical clearance from the hospital's ethical commission. Exclusion criteria included women with diabetes, preeclampsia, autoimmune diseases, and other metabolic disorders. Body mass index (BMI) was calculated as body weight in kilograms divided by height in square meters. HOMA-IR was calculated us- ing the formula: fasting insulin in uU/ml × fasting plasma glucose in mg/dL / 405. Insulin resistance was confirmed if HOMA-IR > 2.44. Data were analyzed using appropriate statistical methods. Results: among the 42 third-trimester pregnant women, 16 were obese, of which 13 had insulin resistance. In the nonobese group of 26 women, 5 had insulin resistance, a statistically significant difference (p < 0.05). HOMA-IR levels in the obese group were 2.99 ± 0.72, while in the nonobese group, they were 1.84 ± 0.57, also showing a statistically significant difference (p < 0.05). Pearson correlation analysis revealed a positive correlation between BMI and HOMA-IR with a coefficient value of 0.804 and a significance value of 0.000.

Conclusion: Normal Obese third-trimester pregnant women had higher levels of HOMA-IR and a higher incidence of insulin resistance. There was a positive correlation between Body Mass Index (BMI) and HOMA-IR in these women.

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