Maternal insulin resistance and preeclampsia

Department of Obstetrics and Gynecology, University of Alabama, Birmingham, School of Medicine, Birmingham, AL 35249-7333, USA.
American journal of obstetrics and gynecology (Impact Factor: 4.7). 04/2011; 204(4):327.e1-6. DOI: 10.1016/j.ajog.2011.02.024
Source: PubMed


The purpose of this study was to determine whether mid-trimester insulin resistance is associated with subsequent preeclampsia.
This was a secondary analysis of 10,154 nulliparous women who received vitamin C and E or placebo daily from 9-16 weeks gestation until delivery. Of these, 1187 women had fasting plasma glucose and insulin tested between 22 and 26 weeks gestation. Insulin resistance was calculated by the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index.
Obese women were twice as likely to have a HOMA-IR result of ≥75th percentile. Hispanic and African American women had a higher percentage at ≥75th percentile for HOMA-IR than white women (42.2%, 27.2%, and 16.9%, respectively; P < .001). A HOMA-IR result of ≥75th percentile was higher among the 85 nulliparous women who subsequently had preeclampsia, compared with women who remained normotensive (40.5% vs 24.8%; adjusted odds ratio, 1.9; 95% confidence interval, 1.1-3.2). Quantitative insulin sensitivity check index results were similar to the HOMA-IR results.
Midtrimester maternal insulin resistance is associated with subsequent preeclampsia.

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Available from: Jorge E Tolosa, Oct 03, 2015
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    • "Our study suggested that insulin resistance during the first trimester among the members of the group which consequently developed preeclampsia was significantly different from the control group. This finding is consistent with previous findings [13, 16]. Other studies did not find such relationship [21]. "
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    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.
    04/2014; 2014:140851. DOI:10.1155/2014/140851
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    • "These findings suggest that the differentially-expressed genes in preeclamptic placentas were related to dysregulation of various signaling pathways, which further contributes to the pathogenesis of preeclampsia. Insulin resistance has long been known as a risk factor for preeclampsia, which could help to explain the link with future cardiovascular disease (Carty et al., 2010; Hauth et al., 2011). Furthermore, experimental and epidemiological evidence has indicated that fatty acids can improve glucose tolerance and prevent insulin resistance (Ebbesson et al., 2005; Ghafoorunissa et al., 2005). "
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    ABSTRACT: The purpose of this study was to perform a comprehensive analysis of gene expression profiles in placentas from preeclamptic pregnancies versus normal placentas. Placental tissues were obtained immediately after delivery from women with normal pregnancies (n=6) and patients with preeclampsia (n=6). The gene expression profile was assessed by oligonucleotide-based DNA microarrays and validated by quantitative real-time RT-PCR. Functional relationships and canonical pathways/networks of differentially-expressed genes were evaluated by GeneSpring™ GX 11.0 software, and ingenuity pathways analysis (IPA). A total of 939 genes were identified that differed significantly in expression: 483 genes were upregulated and 456 genes were downregulated in preeclamptic placentas compared with normal placentas (fold change ≥ 2 and p<0.05 by unpaired t-test corrected with Bonferroni multiple testing). The IPA revealed that the primary molecular functions of these genes are involved in cellular function and maintenance, cellular development, cell signaling, and lipid metabolism. Pathway analysis provided evidence that a number of biological pathways, including Notch, Wnt, NF-κB, and transforming growth factor-β (TGF-β) signaling pathways, were aberrantly regulated in preeclampsia. In conclusion, our microarray analysis represents a comprehensive list of placental gene expression profiles and various dysregulated signaling pathways that are altered in preeclampsia. These observations may provide the basis for developing novel predictive, diagnostic, and prognostic biomarkers of preeclampsia to improve reproductive outcomes and reduce the risk for subsequent cardiovascular disease.
    Omics: a journal of integrative biology 06/2012; 16(6):301-11. DOI:10.1089/omi.2011.0066 · 2.36 Impact Factor
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    • "In fact, PCOS is a condition that is characterized by a chronic insulin-resistant state present before pregnancy, as was observed in the current study, and is exacerbated by the physiological changes that lead to insulin resistance during pregnancy (4). In this regard, adverse maternal/perinatal/neonatal outcomes, which are related to the insulin resistance state (such as pregnancy-induced hypertension, preeclampsia, the type of delivery, and the gestational age at delivery) (17), occurred more frequently in PCOS patients than in the controls. "
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    ABSTRACT: To test the hypothesis that the risk of persistent glucose impairment after gestational diabetes mellitus (GDM) is increased in patients with polycystic ovary syndrome (PCOS). The prospective case-control study included 42 pregnant patients with PCOS and GDM and 84 pregnant control patients with GDM but without clinical and biochemical hyperandrogenism, polycystic ovaries, and oligo-anovulation. The case and control subjects were matched one to two for age and BMI. The glycemic profiles were studied in all subjects 6 weeks, 12 weeks, and 18 months after delivery. The incidence and the relative risk (RR) were calculated for overall persistence of an abnormal glycemic pattern and for each specific alteration, i.e., impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus (DM). At 18 months after delivery, the incidences of IFG, IGT, and IFG-IGT were significantly (P < 0.05) higher in the cases than in the controls. At the 18-month follow-up, the RR for the composite outcome of glucose metabolism impairment in PCOS women was 3.45 (95% CI 1.82-6.58). Patients with PCOS are at increased risk for a persistent impaired glucose metabolism after GDM.
    Diabetes care 02/2012; 35(4):861-7. DOI:10.2337/dc11-1971 · 8.42 Impact Factor
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