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Published on: December 7, 2017
Pregnancy-induced hypertension and insulin resistance: evidence for a connection
1Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262, USA.
Insights
Pregnancy-induced hypertension (PIH) is linked to insulin resistance, a condition also seen in metabolic syndrome. Research suggests insulin resistance may cause PIH, with PIH potentially being an early sign of metabolic syndrome during pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Endocrinology
- Metabolic Disorders
Background:
- Pregnancy-induced hypertension (PIH) is a leading cause of maternal and infant mortality, with its etiology poorly understood.
- Existing evidence suggests a strong link between PIH and insulin resistance (IRS).
- PIH shares clinical features with IRS, including hypertension, dyslipidemia, and endothelial dysfunction.
Purpose of the Study:
- To explore the association between PIH and insulin resistance.
- To investigate whether insulin resistance may play a causal role in PIH development.
- To determine if PIH is an early manifestation of IRS during pregnancy.
Main Methods:
- Systematic review and meta-analysis of controlled studies.
- Prospective investigations assessing insulin sensitivity, glucose intolerance, and hyperinsulinemia.
- Analysis of clinical features common to PIH and IRS.
Main Results:
- Multiple studies confirm a significant positive association between PIH (both proteinuric and non-proteinuric) and various measures of insulin resistance.
- Prospective studies indicate that hyperinsulinemia, glucose intolerance, and insulin insensitivity predict the development of PIH.
- PIH exhibits characteristics mirroring those of IRS, such as hypertension, dyslipidemia, and coagulation abnormalities.
Conclusions:
- Insulin resistance is strongly associated with pregnancy-induced hypertension.
- Insulin resistance may play a causal role in the pathogenesis of PIH.
- PIH could represent an early manifestation of insulin resistance syndrome, exacerbated by pregnancy's metabolic demands.
Abstract:
PIH, the most common complication of pregnancy, remains a major source of maternal-child morbidity and mortality. Yet the etiology of this disorder is still little understood. There is now a growing body of evidence linking PIH and insulin resistance. Both proteinuric and non-proteinuric PIH predict future essential hypertension, and to a lesser extent, diabetes, disorders strongly related to glucose intolerance and insulin resistance. PIH is associated with diabetes, occurring in up to 50% of diabetic pregnancies. PIH is characterized by the same features that define IRS, including hypertension, dyslipidemia, disruption of endothelial and platelet function and related disturbances of prostanoid synthesis, coagulation and fibrinolytic abnormalities, hyperuricemia, atherosclerotic changes, and obesity. During the last decade, controlled studies by at least 11 different research groups in nine countries have established significant positive associations between both proteinuric and nonproteinuric PIH and various measures of insulin resistance. In particular, prospective investigations by at least five groups of investigators have indicated that relative hyperinsulinemia, glucose intolerance, and insulin insensitivity predict the subsequent development of PIH. These and other studies suggest that insulin resistance may play a causal role in the pathogenesis of PIH, and that some aspects of PIH may represent an early manifestation of IRS, precipitated by the profound metabolic and hemostatic challenges of gestation.
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