Hypertensive disorders of pregnancy: a manifestation of insulin resistance

Authors

  • Satyabhama Marandi Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Surya D. Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Kabita Chanania Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Tapasi Pati Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Sibananda Nayak Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Anju Mariam Jacob Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
  • Praveen Kumar R. Department of Radiodiagnosis, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231551

Keywords:

CMIA technology, Fasting serum insulin, Hypertensive disorders of pregnancy, Insulin resistance

Abstract

Background: Pregnancy is a unique physiological diabetogenic state characterised by increased insulin resistance that ensures adequate supply of nutrients to the developing fetus. The insulin sensitivity falls to upto 50 percent in the late pregnancy. Thus insulin resistance and the resultant hyperinsulinemia are the characteristics features that are evident in the normal pregnancy during third trimester. In Hypertensive disorders of pregnancy (HDP), there is exacerbation of the physiological insulin resistance that occurs in normal pregnancy resulting in increased fasting serum insulin level.

Methods: This is a case control study conducted on 90 antenatal women, during the study period of one and half years (from December 2020 to June 2022) in IMS and SUM Hospital, Bhubaneswar. With informed written consent and after fulfilling the criterias, 60 normotensive patients were chosen as controls and 30 pregnant patients with hypertensive disorders of pregnancy were chosen as cases. After 8 hours of overnight fasting, 2ml of blood is drawn and processed by CMIA technology to detect fasting serum insulin levels. The mean fasting serum insulin levels were compared between the cases and the controls.

Results: The mean fasting serum insulin level of controls was found to be 9.27 and the mean fasting serum insulin level of cases was found to be 15.01 which was higher than controls. This was found to be statistically significant with a P value of 0.000.

Conclusions: Increased fasting serum insulin level is observed in women with HDP than normotensive pregnant women.

References

Abhari FR, Ghanbari Andarieh M, Farokhfar A, Ahmady S. Estimating rate of insulin resistance in patients with preeclampsia using HOMA-IR index and comparison with nonpreeclampsia pregnant women. BioMed Res Inter. 2014;2014:1-6.

ACOG Committee on Obstetric Practice. ACOG practice bulletin No. 33: diagnosis and management of preeclampsia and eclampsia. American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet. 2002;77:67-75.

Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Revi. 2018;98(4):2133-223.

Czech MP. Insulin action and resistance in obesity and type 2 diabetes. Nature Med. 2017;23(7):804-14.

Reece EA, Homko C, Wiznitzer A. Metabolic changes in diabetic and nondiabetic subjects during pregnancy. Obstet Gynecolog Surv. 1994;49(1):64-71.

Scioscia M, Gumaa K, Rademacher TW. The link between insulin resistance and preeclampsia: new perspectives. J Reprod Immunol. 2009;82(2):100-5.

Catalano PM. Obesity and pregnancy-the propagation of a viscous cycle?. J Clin Endocrinol Metabol. 2003;88(8):3505-6.

Catalano PM. Trying to understand gestational diabetes. Diabet Med. 2014;31(3):273-81.

Scioscia M, Williams PJ, Gumaa K, Fratelli N, Zorzi C, Rademacher TW. Inositol phosphoglycans and preeclampsia: from bench to bedside. J Reprod Immunol. 2011;89(2):173-7.

Bauman WA, Maimen M, Langer O. An association between hyperinsulinemia and hypertension during the third trimester of pregnancy. Ame J Obstet Gynecol. 1988;159(2):446-50.

Hamasaki T, Yasuhi I, Hirai M, Masuzaki H, Ishimaru T. Hyperinsulinemia increases the risk of gestational hypertension. Inter J Gynecol Obstet. 1996;55(2):141-5.

Fuh MM, Yin CS, Pei D, Sheu WH, Jeng CY, Chen YD, et al. Resistance to insulin-mediated glucose uptake and hyperinsulinemia in women who had preeclampsia during pregnancy. Ame J Hypert. 1995;8(7):768-71.

Malek-Khosravi S, Kaboudi B. Insulin changes in preeclamptic women during pregnancy. Annals Saudi Med. 2004;24(6):434-6.

Solomon CG, Carroll JS, Okamura K, Graves SW, Seely EW. Higher cholesterol and insulin levels in pregnancy are associated with increased risk for pregnancy-induced hypertension. Ame J hypert. 1999;12(3):276-82.

Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997-2008. BMC Pregn Child. 2012;12(1):1-5.

Bdolah Y, Elchalal U, Natanson-Yaron S, Yechiam H, Bdolah-Abram T, Greenfield C, et al. Relationship between nulliparity and preeclampsia may be explained by altered circulating soluble fms-like tyrosine kinase 1. Hypertension Pregn. 2014;33(2):250-9.

Roberts JM, Bodnar LM, Patrick TE. Powers Rw. The Role of obesity in preeclampsia. Pregnancy Hypertens. 2011;1(1):6-16.

Lucas CP, Estigarribia JA, Darga LL, Reaven GM. Insulin and blood pressure in obesity. Hypertension. 1985;7(5):702-6.

Thadhani R, Stampfer MJ, Hunter DJ, Manson JE, Solomon CG, Curhan GC. High body mass index and hypercholesterolemia: risk of hypertensive disorders of pregnancy. Obstet Gynecol. 1999;94(4):543-50.

Laakso M. How good a marker is insulin level for insulin resistance?. Ame J Epidemiol. 1993;137(9):959-65.

Lei Q, Lv LJ, Zhang BY, Wen JY, Liu GC, Lin XH, et al. Ante-partum and post-partum markers of metabolic syndrome in pre-eclampsia. J Human Hypert. 2011;25(1):11-7.

Tripathy C, Malik S, Shah P, Lakshmy R, Tripathy D. Serum insulin and lipid profile in normal pregnant and pregnancy‐induced hypertensive women from North India. Australian and New Zealand J Obstet Gynaecol. 1999;39(3):321-3.

Downloads

Published

2023-05-26

Issue

Section

Original Research Articles