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First trimester insulin resistance and subsequent preeclampsia: a prospective study
Myles Wolf1, Laura Sandler, Kristine Muñoz
1Renal Unit, Departments of Medicine and Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. mswolf@partners.org
The Journal of Clinical Endocrinology and Metabolism
|April 5, 2002
Summary
Early pregnancy insulin resistance, indicated by low Sex Hormone-Binding Globulin (SHBG) levels, is linked to a higher risk of preeclampsia. Lower SHBG in the first trimester may predict preeclampsia, particularly in lean women.
Area of Science:
- Reproductive Endocrinology
- Metabolic Health
- Obstetrics
Background:
- Insulin resistance is a known factor in preeclampsia development.
- Prospective data on insulin resistance markers during pregnancy are limited.
- Sex Hormone-Binding Globulin (SHBG) is a recognized marker for insulin resistance in non-pregnant individuals.
Purpose of the Study:
- To investigate the association between first-trimester SHBG levels and the risk of developing preeclampsia.
- To test the hypothesis that reduced SHBG, indicating insulin resistance, predicts preeclampsia in nulliparous women.
Main Methods:
- A prospective, nested case-control study was conducted.
- First-trimester SHBG levels were measured in 45 women who developed preeclampsia and 90 normotensive controls.
- Statistical analyses included logistic regression, adjusting for covariates and stratifying by body mass index.
Main Results:
- Women who developed preeclampsia had significantly lower first-trimester SHBG levels compared to controls (302 vs. 396 nmol/L).
- Each 100 nmol/L increase in SHBG was associated with a 31% reduced risk of preeclampsia (OR 0.69, P < 0.01), an association that remained significant after adjustment.
- The association between lower SHBG and preeclampsia risk was stronger in lean women.
Conclusions:
- Increased insulin resistance in early pregnancy, as indicated by lower SHBG levels, is independently associated with subsequent preeclampsia.
- First-trimester SHBG may serve as a valuable biomarker for preeclampsia prediction, especially in lean women.
- Overweight women exhibited lower SHBG levels overall, and the association with preeclampsia was less pronounced in this group.