Insulin Resistance and serum Leptin levels in women with Gestational Diabetes Mellitus GÖKÇE ANIK İLHAN Yasemin Emiroğlu Çekiç1, Gökçe Anık İlhan2, Kadir Güzelmeriç1, Orhan Ünal3, Cem Turan1 1 Department of Obstetrics and Gynecology, Dr Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey. 2 Department of Obstetrics and Gynecology, Marmara University, Istanbul, Turkey

WHAT IS KNOWN ALREADY Gestational-diabetes affects 3% to 6 % of all pregnancies Specific treatment-in addition to- routine antenatal-care should be considered to reduce the risks of maternal-perinatal morbidity Alwan et al., 2009;

WHAT IS KNOWN ALREADY Leptin - stimulates glucose uptake and fatty acid oxidation in skeletal muscle, prevents lipid accumulation in non-adipose tissues, inhibits insulin secretion through leptin receptors on pancreatic b-cells Bell et al.,2007

WHAT IS KNOWN ALREADY Placental tissue have been identified as a major source of leptin during pregnancy Conflicting data-maternal leptin concentrations may or may not be increased in GDM. Leptin may play a key role in the development of insulin resistance-increased insulin levels may stimulate leptin production The objective of this study is to assess leptin levels, and IR in women with GDM. Kautzky-Willer A et al.,2001; Bell et al.,2007;;Saucedo R et al.,2011; Syeda Sadia F et al., 2016

STUDY DESİGN 30 pregnant women, at 24-28 weeks of gestation, who attended our outpatient antenatal clinic and diagnosed to have GDM by using 75g OGTT and 30 control subjects were enrolled after obtaining written informed consent from all participants. Clinical, hormonal and metabolic parameters were compared between the two groups.

STUDY DESİGN The diagnosis of the GDM was made according to the IADPSG/ADA criteria, when any of the following plasma glucose values are exceeded: fasting >= 92 mg/dl, 1h: >= 180 mg/dl, 2h: 153 mg/dl. Insulin resistance, defined by HOMA-IR (homeostasis model assessment insulin resistance index), was calculated using the following equation: HOMA-IR = fasting insulin (µU/L) x fasting glucose (mmol/L)/22.5.

RESULTS There was no statistically significant difference between groups in terms of age, BMI However, HOMA-IR, serum leptin, HbA1c, fasting glucose and insulin levels were statistically significantly higher in group 1 compared to those in groups 2.

RESULTS A value of 19.36 for leptin provides a sensitivity of 60% and a specificity of 74% to accurately classify individuals with GDM. The AUC was calculated as 0.66 (CI %95: 0.528-0.803) , p=0.028. There was no statistically significant correlation between levels of leptin and HOMA-IR, BMI, HbA1c, fasting , 1h and 2h glucose levels.

Gestational Diyabetes RESULTS Group 1 N=30 Group 2 N=30   Grup 1 Gestational Diyabetes (N=30) Grup 2 Control P Age (year) 30.90±5.28 28.30±5.12 0.058 Gestational Age 25.63±1.27 25.43±0.97 0.497 BMI ( kg/m² ) 30.05±4.43 27.82±4.45 0.057 Fasting Glucose(mg/dl) 98.63±15.17 78.36±6.57 <0.001 Fasting Insulin (uU/ml) 10.31±5.62 7.11±2.78 0.007 Leptin (ng/ml) 21.61±14 14.78±9.83 0.033 HOMA-IR 2.58±1.61 1.36±0.52 HbA1c (%) 4.97±0.50 4.42±0.78 0.002 . Values are expressed as Mean±SD or N (%)

RESULTS

Conclusions In conclusion, this study demonstrates higher leptin levels and insulin resistance index in GDM subjects. Evaluating insulin resistance and leptin levels between 24-28 weeks of gestation may be clinically important. This issue still needs to be investigated and verification by large studies is needed.