History of gestational diabetes, insulin resistance and coronary risk

The purpose of this study was to examine characteristics associated with th e insulin metabolic syndrome, including insulin resistance, abnormal glucos e tolerance, dyslipidemia, obesity, and elevated blood pressure, among wome n who have experienced gestational diabetes. 39 nondiabetic, young (20-42 y ears), postpartum (3-18 months) white women were recruited from obstetrical clinics. Twenty-one women had a history of gestational diabetes; 18 had un complicated pregnancies. Multivariate analyses revealed a significant diffe rence between groups in insulin resistance (M, measured by euglycemic clamp ) and insulin levels (from an oral glucose tolerance test), with insulin re sistance showing a statistically stronger difference than insulin levels. G roups also differed significantly when compared on a set of variables assoc iated with insulin metabolic syndrome: glucose tolerance, triglycerides, bl ood pressure, and body-mass index. Using insulin resistance as a covariate eliminated these group differences, suggesting that insulin resistance is t he key factor underlying insulin metabolic syndrome. The higher risk of lat er developing type 2 diabetes and hypertension in women who have a history of gestational diabetes is explicable by their poorer profile on variables associated with insulin metabolic syndrome, and appears to be attributable to insulin resistance. Thus, insulin resistance appears to distinguish youn g women at risk for cardiovascular disease. (Journal of Diabetes and Its Co mplications 13;4:216-223, 1999.) (C) 1999 Elsevier Science Inc.