| Author |
Hughes, Brenna L. Clifton, Rebecca G. Hauth, John C. Leveno, Kenneth J. Myatt, Leslie Reddy, Uma M. Varner, Michael W. Wapner, Ronald J. Mercer, Brian M. Peaceman, Alan M. Ramin, Susan M. Tolosa, Jorge E. Saade, George Sorokin, Yoram |
| Description |
Author Affiliation: Hughes BL ( Department of Obstetrics and Gynecology, Women & Infants Hospital, Brown University, Providence, Rhode Island.); Clifton RG ( The George Washington University Biostatistics Center, Washington, District of Columbia.); Hauth JC ( Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.); Leveno KJ ( Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas.); Myatt L ( Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio.); Reddy UM ( The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland.); Varner MW ( Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah.); Wapner RJ ( Department of Obstetrics and Gynecology, Columbia University, New York, New York.); Mercer BM ( Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.); Peaceman AM ( Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.); Ramin SM ( Department of Obstetrics and Gynecology, Children's Memorial Hermann Hospital, University of Texas Health Science Center at Houston, Houston, Texas.); Tolosa JE ( Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon.); Saade G ( Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.); Sorokin Y ( Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.) |
| Abstract |
Objective The objective of this study was to examine whether there is an association between insulin resistance and subsequent development of puerperal infection by measuring insulin resistance in the mid-trimester using the homeostasis model assessment (HOMA:IR). Methods Secondary analysis of low-risk nulliparas enrolled in a multicenter preeclampsia prevention trial. HOMA:IR was measured on fasting plasma glucose and insulin concentrations among low-risk nulliparas between 22 and 26 weeks' gestation. Median HOMA:IR was compared between women who did and did not develop puerperal infection using Wilcoxon rank sum test. Logistic regression was used to control for potential confounders. Results Of 1,180 women with fasting glucose and insulin available, 121 (10.3%) had a puerperal infection. Median HOMA:IR was higher among those with subsequent puerperal infection (4.3 [interquartile, IQR: 2.2-20.5] vs. 2.6 [IQR: 1.5-6.7], p < 0.0001). After controlling for potentially confounding variables HOMA:IR was only marginally associated with an increased risk of development of puerperal infection, adjusted odds ratio: 1.01 (95% confidence interval: 1.00-1.02; p = 0.04) per unit increase. Elevated HOMA:IR performed poorly as a predictor of puerperal infection, with a positive predictive value of 15% and a negative predictive value of 92%. Conclusion Though associated with an increased risk of puerperal infection, insulin resistance, measured by HOMA:IR, is not a clinically useful predictor of puerperal infection. |
