Insulin Resistance in Recurrent Miscarriage
Condition: Insulin Resistance
MeSH terms: Abortion, Spontaneous; Abortion, Habitual; Insulin Resistance
Study type: Observational [Patient Registry]

Summary: 
      The objective of this study is to study the association between insulin resistance and
      recurrent spontaneous miscarriage (RSM).
    

Detailed description: 
      This a case-control study which was performed during the period from (December 2013) till
      (June 2014). Researcher had 80 participants presented to the outpatient clinic in Ain Shams
      University Maternity hospital; they were classified into two groups: (Group A) case group: 40
      pregnant females at 6- 13wks presenting with a history of recurrent pregnancy loss (two or
      more failed clinical pregnancies as documented by ultrasonography or histopathology
      examination according to the American Society of Reproductive Medicine). (Group B) control
      group: 40 pregnant females at 6- 13wks with no history of abortion. They were selected
      according to inclusion and exclusion criteria:

        -  Inclusion criteria:

             1. Women in the child bearing period between 23-40 years.

             2. All patients were pregnant.

             3. The gestational age of both groups 6-13 weeks(1st trimester)

        -  Exclusion criteria:

             1. Patients with history of gestational diabetes.

             2. The patients on medication that could affect glucose metabolism at the time of the
                study (as metformin, Pioglitazone,rosiglitazone).

             3. Patients with other causes of recurrent abortion as (thyroid dysfunction, uterine
                anomalies, chromosomal abnormalities, antiphospholipid antibody syndrome).

             4. Patients with PCOS in the control group (they have insulin resistance).

             5. Obese patients (BMI >30).

      The study was conducted after approval of the hospital ethical committee and a written
      consent was taken from all cases and controls participating in the study after full
      explanation. For all participants detailed history taking, full examination including body
      mass index was taken. The subjects were asked to go on a normal diet for 3 days prior to oral
      glucose tolerance test (OGTT). A fast for 8-10 h was required prior to sampling. A venous
      blood sample was drawn on the following morning from each subject to determine the
      concentrations of fasting glucose (FG) and fasting insulin (FI), afterwards subjects were
      required to drink a mixture of 75 g of pure glucose in 250 ml of water, venous blood samples
      were drawn again after 1, 2, and 3 h to determine the concentrations of glucose and insulin
      blood samples for determination of fasting glucose and fasting insulin after 8-10hours
      fasting and oral glucose tolerance test. Glucose concentration was determined using the
      hexokinase endpoint method; while insulin concentration was determined using the
      immunoluminescence method. The Immulite2000 Immunoassay Analyzer was used along with the
      necessary reagents. The homeostasis model assessment of insulin resistance index (HOMA-IR)
      for each subject was calculated as follows: [FI (U/ ml) ×FG (mmol/l)]/22.5.The larger the
      HOMA-IR, the more severe the degree of IR. HOMA-B, which represents the endocrine function of
      insulin, is calculated as 20× FI/ (FG-3.5). I 60 /I 0 represent the rate of 1-hour insulin to
      1-hour glucose, and I60 / G60 represent the rate of 1-hour insulin increase to 1-hour glucose
      increase. Both values reflect the endocrine functions of B cells of the pancreatic gland. The
      area under the curve of glucose (AUCG) is equal to half of the FG plus

      1-hour glucose, 2-hour glucose, and half of the 3-hour glucose. The area under the curve of
      insulin (AUCI) is also computed in this manner for insulin. The ratio AUCI/AUCG represents
      the rate of AUCI to AUCG, and the higher the rate, the more severe the degree of IR.
    

Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        pregnant females in their first trimester (6- 13 weeks Gestational Age)