Estimating Rate of Insulin Resistance in Patients with Preeclampsia Using HOMA-IR Index and Comparison with Nonpreeclampsia Pregnant Women

Abstract

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.

Pregnancy-Induced hypertension

“…54 Moreover, coexisting metabolic factors can contribute to endothelial dysfunction, and hyperlipidaemia and insulin resistance have been associated with preeclampsia. [55][56][57] Immune factors, such as auto-antibodies, oxidative stress and natural killer (NK)-cell abnormalities, cause placental dysfunction and impaired placental perfusion. The latter acts as a stimulus of placental release of anti-angiogenic and inflammatory mediators that eventually cause endothelial dysfunction and organ damage.…”

siRNA‐mediated NCAM1 gene silencing suppresses oxidative stress in pre‐eclampsia by inhibiting the p38MAPK signaling pathway

“…PE has been recognized as a contributor to maternal mortality and morbidity and affects 3% to 5% of pregnant women worldwide . Beyond the familiar maternal risks such as diabetes mellitus, hypertension, aging, obesity, multiple gestations, and antiphospholipid antibody syndrome, the roles of immunological and genetic factors in PE pathogenesis have also been studied . During pregnancy, the increased susceptibility to oxidative stress (OS) conceivably contributes to indiscriminate damage to biological molecule function when the antioxidant defense cannot bear the reactive O 2 species production .…”

“…2,3 Beyond the familiar maternal risks such as diabetes mellitus, hypertension, aging, obesity, multiple gestations, and antiphospholipid antibody syndrome, the roles of immunological and genetic factors in PE pathogenesis have also been studied. [4][5][6][7] During pregnancy, the increased susceptibility to oxidative stress (OS) conceivably contributes to indiscriminate damage to biological molecule function when the antioxidant defense cannot bear the reactive O 2 species production. 8,9 Reportedly, pregnancies suffering with PE show disturbance in the pro-oxidant and antioxidant balance, and increased OS as well as the mechanisms of antioxidative defense may be conducive to the process of PE.…”

Proteinuria as the Most Relevant Parameter Affecting Fetuin-A Levels in Preeclampsia

“…Lampinen et al (25) found that early PE may lead to IR disorder. Another study revealed a significant difference in IR state between PE and control groups during the third trimester (26). Practically, all obese women with hypertension have elevated insulin levels (27).…”