Association between neck circumference and glucose tolerance levels at 2-6 months postpartum in women with and without gestational diabetes

Carvalho, Camila Rodrigues de Souza; Dualib, Patricia Medici; Ogassavara, Juliana; Mattar, Rosiane; Dib, Sérgio Atala; de Almeida-Pititto, Bianca

doi:10.20945/2359-4292-2022-0242

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Original Article • Arch. Endocrinol. Metab. 68 • 2024 • https://doi.org/10.20945/2359-4292-2022-0242 copy

Association between neck circumference and glucose tolerance levels at 2-6 months postpartum in women with and without gestational diabetes

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the association between neck circumference (NC) measured during pregnancy and markers of glucose metabolism measured 2-6 months postpartum in women with overweight/obesity with and without gestational diabetes (GDM).

Subjects and methods:

This prospective study enrolled 100 pregnant women (including 50 with GDM) with pregestational body mass index (BMI) ≥ 25 kg and < 40 kg/m². The cohort was stratified according to NC tertiles during pregnancy. Glucose metabolism was assessed in the postpartum period. The association between NC during pregnancy and markers of glucose metabolism postpartum was tested using linear regression analysis.

Results:

Participants with NC in the third tertile, compared with those with NC in the second and first tertiles, had higher levels of glycated hemoglobin (HbA1c; 5.6 ± 0.4% versus 5.4 ± 0.3% versus 5.3 ± 0.2%, respectively, p = 0.006), fasting insulin (13.2 ± 6.6 µIU/mL versus 11.1 ± 5.8 µIU/mL versus 9.5 ± 4.9 µIU/mL, respectively, p = 0.035), homeostasis model for insulin resistance (HOMA-IR; 3.1 ± 1.7 versus 2.5 ± 1.3 versus 2.1 ± 1.2, respectively, p = 0.035) and triglyceride-glucose index (TyG; 4.6 ± 0.2 versus 4.5 ± 0.2 versus 4.5 ± 0.3, respectively, p = 0.010). In crude linear regression analysis, NC measured during pregnancy was significantly associated with levels of fasting plasma glucose, 2-hour glucose, HbA1c, log HOMA-IR, and TyG index. The association remained after adjustment for age, family history of diabetes, and number of pregnancies. When adjusted for pregestational BMI and gestational weight gain, NC remained independently associated with fasting plasma glucose and HbA1c levels.

Conclusion:

The NC measured during pregnancy was positively associated with worse glucose metabolic profile in the postpartum among women with obesity/overweight with and without GDM. The NC measurement may be a feasible tool for early identification of women at a higher risk of developing type 2 diabetes mellitus.

Keywords
Neck circumference; pregnancy; glucose intolerance; type 2 diabetes mellitus; gestational diabetes

	First tertile (NC ≤ 33.3 cm)	Second tertile (NC 33.4-36.3 cm)	Third tertile (NC ≥ 36.4 cm)	P values
Pregestational data
Age (years)	29.0 ± 6.8	31.9 ± 6.6	31.0 ± 6.1	0.206
White ethnicity – n (%)	15 (45.5)	11 (32.4)	18 (54.5)	0.184
High education level – n (%)	11 (33.3)	6 (17.6)	9 (37.3)	0.336
Family history of DM – n (%)	8 (25.0)	16 (47.1)	10 (30.3)	0.141
Physically active – n (%)	14 (42.4)	14 (41.2)	14 (42.4)	0.993
Weight (kg)	70.7 ± 8.6	74.0 ± 9.6	85.9 ± 10.9^a a ,versus first tertile. ^b b ,versus second tertile. A high education level was defined by at least 14 years of schooling. Physical activity levels were deemed to be of moderate intensity when lasting ≥ 75 minutes/week and high intensity when lasting ≥ 150 minutes/week. Abbreviations: BMI, body mass index; DM, diabetes mellitus; GDM, gestational diabetes; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; HOMA-IR, homeostatic model of insulin resistance; LDL, low-density lipoprotein; NC, neck circumference; TyG index, triglyceride-glucose index. The HOMA-IR index was calculated using the formula (fasting insulin in µIU/mL x fasting glucose in mmol/L) / 22.5 and the TyG index was calculated as log (fasting triglycerides in mg/dL X fasting glucose in mg/dL) / 2.	<0.001
BMI (kg/m²)	27.6 ± 2.8	28.6 ± 3.0^a a ,versus first tertile.	32.7 ± 3.8^a a ,versus first tertile. ^b b ,versus second tertile. A high education level was defined by at least 14 years of schooling. Physical activity levels were deemed to be of moderate intensity when lasting ≥ 75 minutes/week and high intensity when lasting ≥ 150 minutes/week. Abbreviations: BMI, body mass index; DM, diabetes mellitus; GDM, gestational diabetes; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; HOMA-IR, homeostatic model of insulin resistance; LDL, low-density lipoprotein; NC, neck circumference; TyG index, triglyceride-glucose index. The HOMA-IR index was calculated using the formula (fasting insulin in µIU/mL x fasting glucose in mmol/L) / 22.5 and the TyG index was calculated as log (fasting triglycerides in mg/dL X fasting glucose in mg/dL) / 2.	<0.001
Number of pregnancies – n (%)	8 (24.2)	14 (41.2)	15 (45.5)	0.168
Gestational data
First and second trimesters
Weight (kg)	73.0 ± 9.8	78.2 ± 9.8	91.5 ± 10.3^a,b	<0.001
Systolic blood pressure (mmHg)	108.7 ± 12.6	111.5 ± 11.3	114.7 ± 11.3	0.194
Diastolic blood pressure (mmHg)	67.4 ± 10.2	67.8 ± 9.6	71.4 ± 10.3	0.307
Third trimester
Weight (kg)	77.7 ± 8.4	82.0 ± 10.0	92.0 ± 11.5^a a ,versus first tertile. ^b b ,versus second tertile. A high education level was defined by at least 14 years of schooling. Physical activity levels were deemed to be of moderate intensity when lasting ≥ 75 minutes/week and high intensity when lasting ≥ 150 minutes/week. Abbreviations: BMI, body mass index; DM, diabetes mellitus; GDM, gestational diabetes; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; HOMA-IR, homeostatic model of insulin resistance; LDL, low-density lipoprotein; NC, neck circumference; TyG index, triglyceride-glucose index. The HOMA-IR index was calculated using the formula (fasting insulin in µIU/mL x fasting glucose in mmol/L) / 22.5 and the TyG index was calculated as log (fasting triglycerides in mg/dL X fasting glucose in mg/dL) / 2.	<0.001
Systolic blood pressure (mmHg)	108.4 ± 11.1	113.0 ± 10.3	119.8 ± 11.7^a a ,versus first tertile.	<0.001
Diastolic blood pressure (mmHg)	66.2 ± 8.3	71.9 ± 9.5	74.9 ± 11.0^a a ,versus first tertile.	0.002
Gestational weight gain (kg)	9.6 ± 6.1	10.5 ± 5.6	9.5 ± 6.3	0.774
Gestational age of delivery (weeks)	38.6 ± 1.6	38.8 ± 1.1	38.4 ± 1.1	0.508
Birth weight (kg)	3.2 ± 0.6	3.2 ± 0.4	3.3 ± 0.4	0.640
Birth weight according to gestational age – n (%)
Small for gestational age	3 (9.1)	1 (³3 Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-9. doi: 10.1016/s0140-6736(09)60731-5 https://doi.org/10.1016/s0140-6736(09)60... )	3 (0.4)	0.306
Adequate for gestational age	25 (75.8)	28 (84.8)	20 (62.5)
Large for gestational age	5 (12.2)	4 (12.1)	9 (28.1)
GDM – n (%)	9 (27.3)	18 (52.9)	23 (69.7)	0.002
Insulin use during pregnancy – n (%)	4 (12.1)	9 (27.3)	16 (50)	0.003
Postpartum data
Physically active – n (%)	0 (0.0)	2 (5.9)	6 (6.3)	0.352
Weight (kg)	71.4 ± 9.3	75.3 ± 11.6	85.6 ± 11.5^a,b	<0.001
BMI (kg/m²)	27.4 ± 3.1	29.4 ± 3.7	32.1 ± 3.6^a,b	<0.001
Neck circumference (cm)	33.16 ± 1.32	34.8 ± 2.0^a	37.4 ± 2.6^a,b	<0.001
Systolic blood pressure (mmHg)	110.6 ± 9.6	117.2 ± 8.7^a	115.50 ± 9.50	0.013
Diastolic blood pressure (mmHg)	70.7 ± 6.9	75.4 ± 7.5^a	74.5 ± 5.9	0.016
Total cholesterol (mg/dL)	194.7 ± 38.2	190.5 ± 49.5	194.4 ± 40.0	0.904
LDL cholesterol (mg/dL)	116.6 ± 34.3	113.1 ± 43.0	117.4 ± 35.2	0.887
HDL cholesterol (mg/dL)	56.5 ± 12.0	56.2 ± 9.1	52.2 ± 12.0	0.230
Triglycerides (mg/dL)	109.4 ± 68.6	93.5 ± 47.8	124.0 ± 43.1^b	0.018
Fasting plasma glucose (mg/dL)	90.6 ± 8.6	90.2 ± 10.2	95.3 ± 14.1	0.131
2-hour plasma glucose (mg/dL)	105.8 ± 34.8	99.6 ± 19.6	119.8 ± 42.0	0.050
HbA1c (%)	5.3 ± 0.2	5.4 ± 0.3	5.6 ± 0.4^{a, b}	0.006
Fasting insulin (µIU/mL)	9.5 ± 4.9	11.1 ± 5.8	13.2 ± 6.6^a	0.041
2-hour insulin (µIU/mL)	42.4 ± 39.7	44.4 ± 29.0	57.2 ± 39.6	0.230
HOMA-IR	2.1 ± 1.2	2.5 ± 1.3	3.1 ± 1.7^a	0.035
TyG index	4.5 ± 0.3	4.5 ± 0.2	4.6 ± 0.2^b	0.010
Prediabetes – n (%)	7 (23.3)	7 (21.2)	9 (28.1)	0.802

	Fasting glucose (mg/dL)		2-hour glucose (mg/dL)		HbA1c (%)		Fasting insulin (µUI/mL)		Log HOMA-IR		TyG index
	β (95% CI)	p	β (95% CI)	p	β (95% CI)	p	β (95% CI)	p	β (95% CI)	p	β (95% CI)	p
Crude	1.22 (0.30-2.13)	0.010	3.09 (0.27-5.91)	0.032	0.05 (0.02-0.08)	0.001	0.64 (0.15-1.14)	0.011	0.07 (0.02-0.11)	0.006	0.03 (0.008-0.05)	0.008
Model 1	1.33 (0.43-2.24)	0.004	3.16 (0.47-5.84)	0.022	0.05 (0.02-0.08)	0.002	0.71 (0.20-1.22)	0.006	0.07 (0.03-0.12)	0.003	0.03 (0.009-0.05)	0.006
Model 2	1.42 (0.29-2.55)	0.015	2.48 (-0.79-5.75)	0.136	0.52 (0.1-0.09)	0.006	0.50 (-0.11-1.17)	0.107	0.05 (-0.00-0.11)	0.072	0.02 (-0.006-0.04)	0.138
Model 3	0.90 (-0.26 – 2.07)	0.128	1.08 (-2.31-4.47)	0.529	0.04 (-0.00-0.07)	0.060	0.55 (-1.01-1.21)	0.096	0.05 (-0.01-0.12)	0.085	0.01 (-0.011-0.04)	0.259

	Women who attended the postpartum evaluation (n=100)	Women who were lost to follow-up (n=43)	P values
Age (years)	30.7 ± 6.6	30.2 ± 5.7	0.661
Family history of DM	34 (34.3)	15 (35.7)	0.876
Physical activity	42 (42.0)	19 (45.2)	0.722
Pregestational BMI (kg/m²)	29.7 (3.9)	30.0 (3.7)	0.603
Gestational diabetes	50 (50.0)	16 (38.1)	0.194
First pregnancy	30 (30.0)	11 (26.2)	0.155
Systolic BP (mmHg)	113.7 ± 11.7	111.2 ± 10.4	0.343
Diastolic BP (mmHg)	71.0 ± 10.2	68.8 ± 10.1	0.350

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[1] Correspondence to: Bianca de Almeida-Pititto Programa de Pós-graduação em Endocrinologia e Metabologia, Universidade Federal de São Paulo Rua Estado de Israel, 639, Vila Clementino 04022-001 – São Paulo, SP, Brazil bapititto@unifesp.br