Adiponectin and insulin resistance in early‐ and late‐onset pre‐eclampsia

Abstract

Objective To evaluate the importance of adiponectin and insulin resistance in early-and late-onset pre-eclampsia.Design A nested case-control study in 72 pregnant women who participated in the first-trimester Down-syndrome-screening programme and who delivered at our hospital.Setting University Hospital, Department of Obstetrics and Gynecology.Population Pregnant women: 36 women with pre-eclampsia of which 20 late onset and 16 early onset were compared with 36 uncomplicated pregnancies who delivered at term.Methods In all the women, insulin resistance was calculated by the homeostasis model assessment ratio (HOMA-IR) and plasma adiponectin was determined using an enzyme-linked immunosorbent assay.Main outcome measures Insulin resistance and adiponectin concentration.Results First-trimester plasma adiponectin mean levels in the whole pre-eclampsia group were significantly lower than that in the control group (8.4 ± 3.3 versus 14.8 ± 4.6 microgram/ml; P < 0.001), whereas first-trimester mean HOMA-IR values were significantly higher in the pre-eclampsia group than that in the control group (2.0 ± 1.1 versus 1.0 ± 0.4; P = 0.01). Plasma adiponectin concentrations at delivery in the pre-eclampsia group were significantly higher than that in the control group (9.2 ± 3.7 versus 7.8 ± 2.6 microgram/ml; P = 0.04). First-trimester plasma adiponectin mean concentrations in the late-onset subgroup were significantly lower compared with the concentrations in early-onset subgroup (6.2 ± 1.4 microgram/ml versus 11.1 ± 3.2 microgram/ ml; P < 0.001), and there was a significant difference in adiponectin plasma values only between women in the late-onset pre-eclampsia group versus those in the control group (P < 0.001). First-trimester mean HOMA-IR values were significantly higher in the late-onset subgroup compared with that of the early-onset subgroup (2.5 ± 1.3 versus 1.3 ± 0.3; P = 0.02), and there was a significant difference only between the control group versus the late-onset subgroup (P = 0.001).Conclusions First-trimester adiponectin and HOMA-IR values seem to select two completely different populations: early-and late-onset pre-eclampsia, which might suggest a different pathogenesis.

Different profiles of circulating angiogenic factors and adipocytokines between early‐ and late‐onset pre‐eclampsia

“…Thus, our data suggest that elevation of circulating adiponectin may be a physiological response to the endothelial dysfunction caused by antiangiogenic factors derived from the placenta in late-onset PE, but not in early-onset PE. This is supported by the report by D'Anna et al 36 that first trimester adiponectin levels in late-onset PE are significantly lower than those in early-onset PE, suggesting that first trimester adiponectin values seem to differentiate two different populations: early-and late-onset PE. However, there were no differences in leptin levels between normal weight and Median (interquartile range).…”

Maternal risk factors for hypertensive disorders in pregnancy: a multivariate approach

“…The adipocytederived factor adiponectin, that is inversely related to insulin resistance and is low in women with obesity, is reduced in those who develop late-PE but not early-PE. 38 Similarly, increasing age is associated with glucose intolerance due to a reduction in insulin sensitivity 39 and abnormal lipid profile with increased triglycerides and cholesterol. 40 We found that Black women are at increased risk of early-PE and that both Black and South Asian women have increased risk for late-PE.…”

The ‘beneficial’ adipokines in reproduction and fertility

“…64 There is nonetheless strong evidence for the association of circulating hypoadiponectinemia during the first trimester with preeclampsia, compared with levels found in normal pregnancies. 65 This pattern is reversed in late pregnancy, as pre-eclampsia is associated with hyperadiponectinemia. 66 Other studies report that hypoadiponectinemia and preeclampsia correlate only when obesity 63 and gestational diabetes 67 are present as complicating factors.…”