THE ROLE OF INSULIN RESISTANCE IN RECURRENT MISCARRIAGE

Abstract

Recurrent pregnancy loss (RPL) is estimated to occur in 2%-4% of reproductive-age couples. Recurrent spontaneous miscarriage (RSM) remains a very disturbing event to the affected patients by this health problem; they are always anxious to find the underlying reasons for their miscarriages. This is also a major challenge to the treating physicians (Diejomaoh et al., 2007). Intensive researches including immunological and genetic studies are still in progress to illustrate the cause of RSM. Chromosomal abnormalities, uterine malformations or anomalies, hypothyroidism, cervical incompetence, antiphospholipid syndrome, bacterial infections and poly-cystic ovary syndrome (PCOS) are some of the etiological factors associated with RSM. There are some reports of high RSM rates in over weight/obese infertile women treated by ART (Maryamet al., 2012). Other reports are the condition of PCOS which is probably linked with obesity; this may be due to the high prevalence of overweight/obesity in PCOS women. PCOS is associated with insulin resistance (IR) independent of total or fat- free body mass which can be a key factor behind the link between PCOS/obesity and the risk of spontaneous abortion (Tian et al., 2007). IR is a condition in which the efficacy of insulin in promoting the absorption andutilization of glucose by organs, tissues, and cells is lower than normal.Individuals with IR show glucose levels that are either normal or high, and insulin levels that are more or no less than normal. IR is often increased in 40% women with PCOS, and hyperinsulinaemia is an etiological factor in the pathogenesis of PCOS. Further studies detected a correlation between increasing insulin resistance and fasting insulin level, with PRL (Ehrmann et al., 2006). This a case-control study which was performed during the period from (December 2013) till (June 2014). We 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 pregnanciesas documented by ultrasonography or histopathology examination according to the American Society of Reproductive Medicine) (ASRM, 2008).