Insulin resistance in pregnancy induced hypertension

ABSTRACT

Pregnancy induced hypertension continues to be a major of pregnancy associated morbidity and mortality. Yet, its exact pathophy sinology remains obscure. There is a growing body of evidence linking insulin resistance and pregnancy induced hypertension. To investigate the association between insulin resistance and pregnancy induced hypertension, subdivided into preeclampsia and gestational hypertension, compared with uncomplicated pregnancies. A prospective observational case-control study. Setting: Obstetric Unit of Cairo University Hospital [Kasr EL-Aini]. Participants: Forty cases in the third trimester of pregnancy with either preeclampsia [n=20] or gestational hypertension [n=20], and 20 normotensive pregnant control. The control and study groups were matched for maternal age [ +/- two years], pre-pregnancy body mass index [ +/- 10%] and gestational age [ +/- one week]. Fasting blood samples were collected from cases and controls. Glucose was using the glucose oxidase method and insulin was measured using radioimmunoassay. Main Outcome Measure: Fasting glucose and insulin levels were compared based on serological data and fasting insulin levels were used as a marker of insulin resistance. The demographic and clinical characteristics, which might influence insulin resistance, were comparable [p>0.05]. The mean fasting glucose levels were not significantly different in the control and study groups [p>0.05]. However, mean fasting insulin levels were significantly lower in the women with preeclampsia compared with the normotensive group [p<0.001]. Conversely, mean fasting insulin levels were significantly higher in the women with gestational hypertension compared with their normotensive counterparts [p<0.001]. As with other forms of secondary hypertension, preeclampsia is not associated with insulin resistance, and like essenential hypertension, gestational hypertension is associated with insulin resistance. Insulin resistance may play a role in the pathogenesis of gestational hypertension, but not preeclampsia