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There is evidence that hyperinsulinemia and insulin resistance play a role in the development of hypertension. Accordingly, in our ongoing longitudinal study of pregnancy-induced hypertension, we have measured fasting levels of insulin and glucose at 18 to 25 weeks gestation in 140 nulliparous African-American women followed prospectively to delivery. To test the hypothesis that hyperinsulinemia may be related to the development of preeclampsia, discriminant analysis of mean arterial pressure (MAP), fasting plasma insulin levels, insulin to glucose ratios, and left lateral forearm vascular resistance were examined as predictors of preeclampsia. Statistical analysis controlled for two factors known to be related to insulin levels, gestational age and pregestational body mass index. Gestational hypertensives were not different with regard to blood pressure and metabolic factors from normals and thus were placed in the control group. Women who subsequently developed preeclampsia had mean (+/- SE) fasting plasma insulin levels of 51.0 +/- 12.0 microU/mL at 20 weeks and controls had values of 29.0 +/- 2.8. Only MAP [F(4,135) = 8.8, P < .01] and insulin [F(1,135) = 6.5, P < .05] were related to the development of preeclampsia [F(4,135) = 4.39, R2 = 11.5%]. The finding that elevated second-trimester insulin levels characterize the subsequent development of preeclampsia with control for increased MAP supports the hypothesis that hyperinsulinemia and associated insulin resistance may contribute to the pathogenesis of preeclampsia.

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In order to determine the prevalence and significance of sonographically thick placentas, we reviewed the computerized records of 18 827 viable, singleton pregnancies. Of these, 116 (0.6%) had thick placentas diagnosed by ultrasound examination. Perinatal mortality was markedly increased among pregnancies with thick placentas (odds ratio = 13.1, 95% confidence limits (CL) = 8.3-20.8), accounting for 6.2%; of the total. The rates of abruptio placentae (odds ratio = 2.9, CL = 1.1-8.1), neonatal intensive care unit admissions (odds ratio = 4.6, CL = 3.1-6.9) and anomalies (odds ratio = 8.4, CL = 4.9-14.4) were also significantly increased among the thick placenta cohort compared to controls. The 106 liveborn neonates with thick placentas had lower Apgar scores, were delivered at an earlier gestational age, and weighed less than controls. Anomalies, hydrops fetalis and abruptio placentae complicated 16 of the 24 cases of perinatal mortalities. Sonographically thick placentas should alert the clinician to the possibility of compromised perinatal outcome.

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