Insulin resistanceglucose intolerance

Increased insulin resistance is seen in pregnancy and is greatest in the third trimester when hypertension typically presents. Obesity, which is a risk factor for hypertension in pregnancy (Eskenazi et al., 1991) is associated with decreased insulin sensitivity. Gestational diabetics also have an increased risk of hypertension in pregnancy (Suhonen and Teramo, 1993). A strong association has been shown between glucose intolerance and subsequent development of hypertension in pregnancy (Solomon et al., 1994). No absolute glucose level can distinguish between women who will remain normotensive and those who will develop new onset hypertension in pregnancy. However, only 9% of normotensives had glucose loading tests of 7.8 mmol or greater compared to 27% of women who develop hypertension. Fasting plasma insulin at 20 weeks gestation in African-American women who became pre-eclamptic was significantly greater than those who remain normotensive (Sowers et al., 1995). Using discriminant analysis, mean blood pressure and fasting insulin levels were predictors of pre-eclampsia. Hence, measurement of glucose tolerance may serve as a useful predictor, alone or in combination with other markers of pre-eclampsia. Very recently, serum SHBG has been studied as a marker of insulin resistance in pregnancy (Wolf et al., 2002). SHBG has potential as a marker of insulin resistance as it has minimal variability between fasting and postprandial states (Key et al., 1990). Increased first trimester SHBG (increased insulin resistance) was independently associated with increased risk of pre-eclampsia, an association that strengthened in lean women (Wolf et al., 2002).

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