{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T05:43:25Z","timestamp":1774849405377,"version":"3.50.1"},"reference-count":55,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>During pregnancy, the maternal body undergoes adaptive regulation to support the normal growth and development of the fetus, such as the occurrence of insulin resistance (IR). When the degree of IR progresses continuously and is significantly higher than the normal range in the corresponding period, it will increase the risk of perinatal complications, including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). The study is to investigate the correlation and influenced factors between different levels of IR during pregnancy and adverse pregnancy outcomes, and to suggest the critical threshold for predicting pathological IR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>By applying the Group-based Trajectory Model (GBTM), the trajectories\u2019 classification based on IR index changes was constructed, including fasting serum insulin (FINS), insulin resistance homeostasis model assessment (HOMA-IR), and the quantitative insulin sensitivity check index (QUICKI), to analyze the differences in the differentiation of IR evaluation indicators. We used the Poisson Regression Model to analyze the correlation between various IR changing trajectories and adverse pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four gradient differences in IR change trajectories were fitted in the population using three IR evaluation indicators respectively, including low level, moderate level, high level and low-high level. For FINS trajectories, the GDM risk of the moderate level trajectory (aRR 1.73, 95% CI 1.21-2.47) and the high-level trajectory (aRR 2.40, 95% CI 1.58-3.65) showed a gradient increase. The low-high level trajectory, which only sharply increased in late pregnancy, exhibited a significantly higher difference in HDP risk (aRR 6.45, 95% CI 1.78-23.33) compared to the high level (aRR 5.86, 95% CI 2.41-14.25). In this study, the early pregnancy IR value of the population was used to predict GDM exhibited similar predictive ability (AUC 0.607, P&amp;lt;0.001). For predicting HDP, FINS showed the highest AUC value of 0.740 (P&amp;lt;0.001), comparing to HOMA-IR and QUICKI showed slightly lower AUC values of 0.73.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There are various subtypes of IR trajectories in pregnant women, which are significantly correlated with adverse pregnancy outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1746255","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T04:11:38Z","timestamp":1774843898000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between insulin resistance trajectories and perinatal complications: a retrospective cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Lisha","family":"Ye","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lixia","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaofeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caixia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiqin","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lepei","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haitian","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, The First Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University","place":["Guangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2147","DOI":"10.2337\/dc22-1894","article-title":"Insulin sensitivity and \u03b2-cell function during early and late pregnancy in women with and without gestational diabetes mellitus","volume":"46","author":"Mittendorfer","year":"2023","journal-title":"Diabetes Care"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-019-4881-6","article-title":"Augmented insulin secretory response in early pregnancy","volume":"62","author":"Powe","year":"2019","journal-title":"Diabetologia"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-025-01164-2","article-title":"A call for a multidisciplinary intervention to address severe insulin resistance during pregnancy","volume":"21","author":"Young","year":"2025","journal-title":"Nat Rev Endocrinol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3390\/nu14122444","article-title":"Role of beta cell function and insulin resistance in the development of gestational diabetes mellitus","volume":"14","author":"Ellerbrock","year":"2022","journal-title":"Nutrients"},{"key":"B5","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1186\/s12884-021-04006-x","article-title":"Associations between insulin resistance and adverse pregnancy outcomes in women with gestational diabetes mellitus: a retrospective study","volume":"21","author":"Lin","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-019-4961-7","article-title":"Characteristics and pregnancy outcomes across gestational diabetes mellitus subtypes based on insulin resistance","volume":"62","author":"Benhalima","year":"2019","journal-title":"Diabetologia"},{"key":"B7","doi-asserted-by":"publisher","first-page":"241.e1","DOI":"10.1016\/j.ajog.2021.08.016","article-title":"Physiological subtypes of gestational glucose intolerance and risk of adverse pregnancy outcomes","volume":"226","author":"Selen","year":"2022","journal-title":"Am J Obstet Gynecol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.clinpsy.121208.131413","article-title":"Group-based trajectory modeling in clinical research","volume":"6","author":"Nagin","year":"2010","journal-title":"Annu Rev Clin Psychol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-081122-012416","article-title":"Recent advances in group-based trajectory modeling for clinical research","volume":"20","author":"Nagin","year":"2024","journal-title":"Annu Rev Clin Psychol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.33955","article-title":"Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes","volume":"5","author":"Chehab","year":"2022","journal-title":"JAMA Netw Open"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2021.106499","article-title":"Pre- and postnatal maternal smoking and offspring smoking trajectories: Evidence from a 20-year birth cohort","volume":"147","author":"Chadi","year":"2021","journal-title":"Prev Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3760\/cma.j.cn112141-20210917-00528","article-title":"Guideline of diagnosis and treatment of hyperglycemia in pregnancy (2022) (Part one)","volume":"57","year":"2022","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"B13","doi-asserted-by":"publisher","first-page":"227","DOI":"10.3760\/cma.j.cn112141-20200114-00039","article-title":"Diagnosis and treatment of hypertension and pre-eclampsia in pregnancy: a clinical practice guideline in China (2020)","volume":"55","year":"2020","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/FM9.0000000000000158","article-title":"A summary of Chinese expert consensus on fetal growth restriction (an update on the 2019 version)","volume":"4","author":"Sun","year":"2022","journal-title":"Matern Fetal Med"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.4239\/wjd.v14.i5.573","article-title":"Intermediate hyperglycemia in early pregnancy: a South Asian perspective","volume":"14","author":"Punnose","year":"2023","journal-title":"World J Diabetes"},{"key":"B16","doi-asserted-by":"publisher","first-page":"S14","DOI":"10.2337\/dc20-S002","article-title":"2. Classification and diagnosis of diabetes: Standards of medical care in diabetes-2020","volume":"43","year":"2020","journal-title":"Diabetes Care"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1017\/s0265021507001111","article-title":"Correlation of calculated indices of insulin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insulin resistance in critically ill patients","volume":"24","author":"Holzinger","year":"2007","journal-title":"Eur J Anaesthesiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.dsx.2022.102581","article-title":"Challenges in the diagnosis of insulin resistance: Focusing on the role of HOMA-IR and tryglyceride\/glucose index","volume":"16","author":"Tahapary","year":"2022","journal-title":"Diabetes Metab Syndr"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.2307\/3109782","article-title":"Testing for trend with count data","volume":"54","author":"Weller","year":"1998","journal-title":"Biometrics"},{"key":"B20","unstructured":"Jones\n              BL\n            \n          \n          Traj: group-based modeling of longitudinal data"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ21-0725","article-title":"New classification and diagnostic criteria for insulin resistance syndrome","volume":"69","author":"Ogawa","year":"2022","journal-title":"Endocr J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.34.4.380","article-title":"Insulin action during pregnancy. Studies with the euglycemic clamp technique","volume":"34","author":"Ryan","year":"1985","journal-title":"Diabetes"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2011.10.009","article-title":"Prediction of gestational diabetes mellitus at 24 to 28 weeks of gestation by using first-trimester insulin sensitivity indices in Asian Indian subjects","volume":"61","author":"Grewal","year":"2012","journal-title":"Metabolism"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-00094","article-title":"Parity increases insulin requirements in pregnant women with type 1 diabetes","volume":"103","author":"Skajaa","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"B25","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1530\/EJE-20-1332","article-title":"Large birth size, infancy growth pattern, insulin resistance and \u03b2-cell function","volume":"185","author":"Huang","year":"2021","journal-title":"Eur J Endocrinol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2021.08.005","article-title":"Preconception insulin resistance and neonatal birth weight in women with obesity: role of bile acids","volume":"43","author":"Wang","year":"2021","journal-title":"Reprod BioMed Online"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2018.07.010","article-title":"Roles of insulin resistance and beta cell dysfunction in macrosomia among Chinese women with gestational diabetes mellitus","volume":"12","author":"Li","year":"2018","journal-title":"Prim Care Diabetes"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/bf00280883","article-title":"Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man","volume":"28","author":"Matthews","year":"1985","journal-title":"Diabetologia"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.ej14-0163","article-title":"The association between maternal insulin resistance in mid-pregnancy and neonatal birthweight in uncomplicated pregnancies","volume":"61","author":"Yamashita","year":"2014","journal-title":"Endocr J"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1177\/11795514221098403","article-title":"Insulin resistance in gestational diabetes mellitus and its association with anthropometric fetal indices","volume":"15","author":"Dinh Le","year":"2022","journal-title":"Clin Med Insights Endocrinol Diabetes"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/5320156","article-title":"Determinants of maternal insulin resistance during pregnancy: an updated overview","volume":"2019","author":"Kampmann","year":"2019","journal-title":"J Diabetes Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1053\/j.gastro.2012.06.031","article-title":"Transfer of intestinal microbiota from lean donors increases insulin sensitivity in individuals with metabolic syndrome","volume":"143","author":"Vrieze","year":"2012","journal-title":"Gastroenterology"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2013-1570","article-title":"Longitudinal relationship of physical activity with insulin sensitivity in overweight and obese pregnant women","volume":"98","author":"van Poppel","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1152\/ajpendo.00645.2007","article-title":"Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage","volume":"294","author":"Muniyappa","year":"2007","journal-title":"Am J Physiol Endocrinol Metab"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.2217\/dmt.10.24","article-title":"Mechanisms in the adaptation of maternal \u03b2-cells during pregnancy","volume":"1","author":"Ernst","year":"2011","journal-title":"Diabetes Manag (Lond)"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.24953\/turkjped.2017.06.002","article-title":"Associations between anthropometric characteristics and insulin markers in mothers and their neonates and with neonate`s birth weight: An observational cohort study","volume":"59","author":"Naseh","year":"2017","journal-title":"Turk J Pediatr"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13013","article-title":"Increasing insulin resistance predicts adverse pregnancy outcomes in women with gestational diabetes mellitus","volume":"12","author":"Sun","year":"2020","journal-title":"J Diabetes"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1007\/s11154-020-09549-6","article-title":"Current perspectives of oleic acid: Regulation of molecular pathways in mitochondrial and endothelial functioning against insulin resistance and diabetes","volume":"21","author":"Rehman","year":"2020","journal-title":"Rev Endocr Metab Disord"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1002\/jbt.22953","article-title":"Genetic mutations of APOE\u03f54 carriers in cardiovascular patients lead to the development of insulin resistance and risk of Alzheimer's disease","volume":"36","author":"Jabeen","year":"2021","journal-title":"J Biochem Mol Toxicol"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1161\/ATVBAHA.123.319200","article-title":"Associations of homeostatic model assessment for insulin resistance trajectories with cardiovascular disease incidence and mortality","volume":"43","author":"Lee","year":"2023","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa031884","article-title":"Circulating angiogenic factors and the risk of preeclampsia","volume":"350","author":"Levine","year":"2004","journal-title":"N Engl J Med"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00560.2015","article-title":"Glucagon actions on the kidney revisited: possible role in potassium homeostasis","volume":"311","author":"Bankir","year":"2016","journal-title":"Am J Physiol Renal Physiol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2005.00720.x","article-title":"Twenty-four-hour urine insulin as a measure of hyperinsulinaemia\/insulin resistance before onset of pre-eclampsia and gestational hypertension","volume":"112","author":"Emery","year":"2005","journal-title":"BJOG"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-015-0427-z","article-title":"Predicting gestational diabetes mellitus during the first trimester using anthropometric measurements and HOMA-IR","volume":"39","author":"Alptekin","year":"2016","journal-title":"J Endocrinol Invest"},{"key":"B45","doi-asserted-by":"publisher","first-page":"410.e1","DOI":"10.1016\/j.ajog.2006.12.011","article-title":"Predicting gestational diabetes: choosing the optimal early serum marker","volume":"196","author":"Smirnakis","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13010060","article-title":"Predictability of HOMA-IR for gestational diabetes mellitus in early pregnancy based on different first trimester BMI values","volume":"13","author":"Duo","year":"2022","journal-title":"J Pers Med"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1111\/j.1464-5491.2005.01634.x","article-title":"Prediction of gestational diabetes mellitus in a high-risk group by insulin measurement in early pregnancy","volume":"22","author":"Bit\u00f3","year":"2005","journal-title":"Diabet. Med."},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2014.973397","article-title":"Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices","volume":"28","author":"Ozgu-Erdinc","year":"2015","journal-title":"J Matern Fetal Neona"},{"key":"B49","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1002\/ijgo.13905","article-title":"HOMA-IR as a risk factor of gestational diabetes mellitus and a novel simple surrogate index in early pregnancy","volume":"157","author":"Song","year":"2022","journal-title":"Int J Gynaecol Obstet"},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0163424","article-title":"Optimal cut-offs of homeostasis model assessment of insulin resistance (HOMA-IR) to identify dysglycemia and type 2 diabetes mellitus: a 15-year prospective study in Chinese","volume":"11","author":"Lee","year":"2016","journal-title":"PloS One"},{"key":"B51","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/s13224-021-01426-9","article-title":"Correlation of insulin resistance in pregnancy with obstetric outcome","volume":"71","author":"Bano","year":"2021","journal-title":"J Obstet Gynaecol India"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.29271\/jcpsp.2021.09.1015","article-title":"Diagnostic accuracy of markers of insulin resistance (HOMA-IR) and insulin sensitivity (QUICKI) in gestational diabetes","volume":"31","author":"Paracha","year":"2021","journal-title":"J Coll Physicians Surg Pak"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1080\/09513590801948416","article-title":"Diagnosis of gestational diabetes mellitus by use of the homeostasis model assessment-insulin resistance index in the first trimester","volume":"24","author":"Ozcimen","year":"2008","journal-title":"Gynecol Endocrinol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics15131704","article-title":"Evaluating the predictive value of HOMA-IR in gestational diabetes: A case-control study from Romania","volume":"15","author":"Iman","year":"2025","journal-title":"Diagnostics (Basel)"},{"key":"B55","doi-asserted-by":"publisher","first-page":"S200","DOI":"10.2337\/dc21-S014","article-title":"Management of diabetes in pregnancy: Standards of medical care in diabetes-2021","volume":"44","year":"2021","journal-title":"Diabetes Care"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1746255\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T04:11:45Z","timestamp":1774843905000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1746255\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":55,"alternative-id":["10.3389\/fendo.2026.1746255"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1746255","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]},"article-number":"1746255"}}