Two-hour insulinemia after oral glucose overload and women at risk of pregnancy-induced hypertensive disorders

Clinical study on the association between pregnancy-induced hypertension and insulin resistance

The aim of the present study was to explore the association between pregnancy-induced hypertension (PIH) and insulin resistance (IR). A total of 50 cases of PIH and 50 healthy pregnant women with a similar gestational age were enrolled. The hyperinsulinemic-euglycemic clamp technique was used to evaluate the degree of IR and all 100 subjects were divided into an IR and a non-IR group accordingly. Subsequently, the correlation between the systolic or diastolic blood pressure was assessed; furthermore, a homeostasis model assessment of IR (HOMA-IR), a HOMA of the insulin sensitivity index (HOMA-ISI) and a HOMA of β cell function (HOMA-β%) were performed. Moreover, the effect of IR on PIH was assessed and the protein expression of insulin receptor substrate (IRS)-1, phosphorylated (p)-IRS-1, AKT and p-AKT were detected in the placental plasma by western blot analysis. The results showed that in the PIH group, the p-IRS-1/IRS-1 and p-AKT/AKT ratios were decreased compared with those in the control group. Blood flow parameters, including perfusion index, retinal resistive index and systolic maximum velocity/end-diastolic velocity ratio in the IR group were higher, while time averaged velocity was lower compared with that in the non-IR group. Furthermore, the HOMA-ISI and HOMA-β% were decreased, while the HOMA-IR was increased in the PIH group compared to that in the control group; alongside the blockage of the insulin signaling pathway, these factors may therefore cause PIH. The present study may provide novel therapeutic approaches for PIH.

Estimating rate of insulin resistance in patients with preeclampsia using HOMA-IR index and comparison with nonpreeclampsia pregnant women

Women with preeclampsia, independent of obesity and glucose intolerance, exhibit insulin resistance during pregnancy. The purpose of the present study is to determine whether early diagnosis of insulin resistance during pregnancy can predict preeclampsia. Through a case-control study, 675 pregnant women were selected and their first trimester blood was taken. Their fasting blood glucose and insulin were also measured after diagnosis of preeclampsia by 20 weeks of pregnancy. Based on the experiments conducted on 675 women who were 20 weeks past their pregnancy, 375 cases with preeclampsia were selected and assigned to the case group. 35 other pregnant women were put in the control group. Diagnosis criteria for the participants included blood pressure above 140/90 and proteinuria above 300 mg or above +1. Both groups were matched according to age, parity, gestational age, and BMI. Homa-Irand rate of insulin resistance was calculated by HOMA-IR and patients were followed up. Homeostatic model assessments (HOMA-IR) revealed that the average insulin resistance increased during pregnancy among both the case and control groups. There was a significant difference between insulin resistance of these two groups in both first trimester and third trimester and after developing preeclampsia (P < 0.001, P = 0.021). Insulin-resistance of the group with preeclampsia was higher in first trimester prior to diagnosis as well as the third trimester after diagnosis compared to natural pregnancy under similar conditions. Measurement of insulin resistance in first trimester may be useful in predicting the risk of preeclampsia.