Maternal insulin resistance and preeclampsia

Hauth, John C.; Clifton, Rebecca G.; Roberts, James M.; Myatt, Leslie; Spong, Catherine Y.; Leveno, Kenneth J.; Varner, Michael W.; Wapner, Ronald J.; Thorp, John M.; Mercer, Brian M.; Peaceman, Alan M.; Ramin, Susan M.; Carpenter, Marshall W.; Samuels, Philip; Sciscione, Anthony; Tolosa, Jorge E.; Saade, George R.; Sorokin, Yoram; Anderson, Garland D.

doi:10.1016/j.ajog.2011.02.024

Cited by 106 publications

(76 citation statements)

References 22 publications

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“…Several abnormalities associated with the development of PE such as lower plasma volume, activation of complement system, hyperferritinemia, insulin resistance and metabolic syndrome are also more prevalent among overweight or obese uninfected patients 22-26 . Futhermore, overweight has been associated with oxidative stress consisting of an imbalance of lipid metabolism and an inflammatory state that is also associated with PE 27 .…”

Section: Discussionmentioning

confidence: 99%

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

Machado

Krauss

Megazzini

et al. 2014

Journal of Infection

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Objectives To evaluate the incidence of and risk factors for hypertensive disorders in a cohort of HIV-infected pregnant women. Methods Hypertensive disorders (HD) including preeclampsia/eclampsia (PE/E) and pregnancy-induced hypertension, and risk factors were evaluated in a cohort of HIV-infected pregnant women from Latin America and the Caribbean enrolled between 2002-2009. Only pregnant women enrolled for the first time in the study and delivered at ≥ 20 weeks gestation were analyzed. Results HD were diagnosed in 73 (4.8%, 95%CI: 3.8%-6.0%) of 1513 patients; 35(47.9%) had PE/E. HD was significantly increased among women with a gestational age-adjusted body mass index (gBMI) ≥ 25 kg/m2 (OR=3.1; 95%CI: 1.9-5.0), hemoglobin (Hg) ≥11 g/dL at delivery (OR=2.1; 95%CI: 1.2-3.6) and age ≥35 years (OR=1.8; 95%CI: 1.1-3.2). PE/E was increased among women with a gBMI ≥25 kg/m2 (OR=3.0; 95%CI: 1.5-6.0) and Hg ≥11 g/dL at delivery (OR=2.8; 95%CI: 1.2-6.5). A previous history of PE/E increased the risk of PE/E 6.7 fold (95%CI: 1.8-25.5). HAART before conception was associated with PE/E (OR=2.3; 95%CI: 1.1-4.9) Conclusions HIV-infected women, with a previous history of PE/E, a gBMI ≥25 kg/m2, Hg at delivery ≥11 g/dL and in use of HAART before conception are at an increased risk of developing PE/E during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

Machado

Krauss

Megazzini

et al. 2014

Journal of Infection

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“…Compared to women who have normotensive pregnancies, women who develop preeclampsia are more insulin resistant prior to pregnancy [14], in the first and second trimesters [15], and years after pregnancy [16]. This effect is partially explained by the fact that many preeclampsia risk factors are also associated with insulin resistance, including obesity, advanced maternal age, non-white race, chronic hypertension, diabetes and gestational diabetes [15, 14]. However, insulin resistance at 22-26 weeks gestation was a significant independent predictor of preeclampsia after adjustment for these common risk factors, suggesting an independent effect [15].…”

Section: Introductionmentioning

confidence: 99%

Preeclampsia and Diabetes

2015

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Preeclampsia is diagnosed in women presenting with new onset hypertension accompanied by proteinuria or other signs of severe organ dysfunction in the second half of pregnancy. Preeclampsia risk is increased two to four-fold among women with type 1 or type 2 diabetes. The limited number of pregnant women with preexisting diabetes and difficulties associated with diagnosing preeclampsia in women with proteinuria prior to pregnancy are significant barriers to research in this high-risk population. GDM also increases preeclampsia risk, although it is unclear whether these two conditions share a common pathophysiological pathway. Non-diabetic women who have had preeclampsia are more likely to develop type 2 diabetes later in life. Among women with type 1 diabetes, a history of preeclampsia is associated with an increased risk of retinopathy and nephropathy. More research examining pathophysiology, treatment and the long-term health implications of preeclampsia among women with preexisting and gestational diabetes is needed.

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“…This hypothesis has been confirmed by a recent publication stating that a diagnosis of IR during pregnancy predisposes to the onset of PE. In that study, primigravid women with a diagnosis of IR determined by a homeostasis model assessment of IR and the quantitative insulin sensitivity check index between gestation weeks 22 and 26 had a higher incidence of PE than control patients (40.5 vs. 24.8%) [23]. …”

Section: Introductionmentioning

confidence: 99%

Assessment of Pregestational Insulin Resistance as a Risk Factor of Preeclampsia

Valdés

Sepúlveda‐Martínez

Manukián

et al. 2014

Gynecol Obstet Invest

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Aim: To assess the impact that pregestational insulin resistance (PIR) has as a risk factor for preeclampsia (PE). Methods: Nested case-control study that included patients with PIR and a control group that was randomly selected from pregnancies admitted to the Fetal Medicine Unit between January 2005 and May 2011. Clinical and hemodynamic variables were analyzed by a multiple logistic regression analysis. Results: Of the 13,124 patients admitted during the study period, 119 had a diagnosis of PIR (0.9%). Patients with PIR were older and had a higher body mass index (BMI). PIR was also related to a significantly higher frequency of chronic hypertension (CrHT; 10.1 vs. 2.2%, p < 0.05) and hypothyroidism (5.0 vs. 1.6%, p < 0.05) than in the control group. Moreover, women with PIR were more likely to develop PE (8.4 vs. 4.2%, p < 0.05) and gestational diabetes mellitus (9.2 vs. 2.9%) than the control group. Multivariate analysis showed that maternal age, CrHT and altered uterine artery Doppler sonography during the first and second trimesters were good predictors of PE and that PIR was not. Conclusion: Although PIR correlates with PE, conditions related to the latter (CrHT, higher maternal age and increased BMI) may be predominant as risk factors for PE.

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Maternal insulin resistance and preeclampsia

Cited by 106 publications

References 22 publications

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

Preeclampsia and Diabetes

Assessment of Pregestational Insulin Resistance as a Risk Factor of Preeclampsia

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