Hypertension in pregnancy: Role of body mass index, insulin resistance, aldosterone, and calcium homeostasis

Abstract

In a recent study, Zhuang and coll. 1 have reported that body mass index (BMI) and calcium supplementation during pregnancy play an important role in the development of pregnancy-induced hypertension (PIH) in a large cohort of Chinese women. In particular, the authors reported that overweight and obese women before pregnancy had an increased prevalence of PIH, delivery before 34 gestational weeks, and other obstetric outcomes of PIH. On the contrary, calcium supplementation (about 600 mg per day) during pregnancy was associated with a significant reduction in PIH and other adverse pregnancy-related outcomes.The authors suggested that the reduction in BMI prior pregnancy and the supplementation of calcium during pregnancy could be useful to prevent the risk of hypertension and of its related complications.Several studies have reported that pre-existing maternal hypertension and increased BMI are strongly associated with negative maternal and fetal outcomes. 2 These conditions increase the onset of gestational diabetes, PIH, and preeclampsia, leading to an increased risk of later-life cardiovascular and metabolic disorders. 3 One of the main factors involved in the pathogenesis of all these disorders is insulin resistance. This is a complex pathological condition characterized by an inappropriate sensitivity to insulin hormone in insulin-dependent tissues, due to different and not completely known mechanisms, including oxidative stress, inflammation, insulin receptor mutations, postreceptor defects, and mitochondrial dysfunction. 4 Insulin resistance plays a key role in the pathogenesis of many metabolic disorders, such as type 2 diabetes mellitus, metabolic syndrome, and polycystic ovary syndrome (PCOS). In particular, insulin resistance is often present even in lean PCOS patients 5 and is involved in the increased risk of PCOS women for developing gestational diabetes mellitus, PIH, preeclampsia, and other obstetrics and cardiovascular events during pregnancy compared with healthy controls. 2 For all these reasons, the treatment of insulin resistance must be considered in all women, especially with PCOS or metabolic syndrome, to prevent or reduce the possible related complications.Metformin is one of the most widely used treatments for type 2 diabetes and other comorbidities associated with insulin resistance. It has been shown to improve ovary function and fertility outcomes in women with PCOS and insulin resistance even underwent to assisted reproductive technologies (ART). 6 Even if its use is safe, the exposure of metformin in pregnancy has still not been elucidated.Recent evidence reported inositol as an effective insulin sensitizer that can be used before and during pregnancy, improving not only the metabolic profile, but also the ovulatory functions 7 and preventing the onset of gestational diabetes. 8The treatment with adequate diet and insulin sensitizers and the reduction in BMI within normal range must be considered in all women, especially if seeking pregnancy, to prevent the complications related ...

Reducing the Risk of Pre-Eclampsia in Women with Polycystic Ovary Syndrome Using a Combination of Pregnancy Screening, Lifestyle, and Medical Management Strategies

“…During pregnancy, additional signaling mechanisms derived from the uteroplacental unit, such as the renin–angiotensin–aldosterone system (RAAS) and angiogenic factors, interact with existing systemic control networks to ensure appropriate fetoplacental blood supply [ 165 ]. Pre-eclampsia is characterized by an imbalance of the RAAS and proangiogenic (PlGF, vascular endothelial growth factor) and anti-angiogenic factors (sFlt-1) [ 166 , 167 ]. Women with PCOS can have alterations in their RAAS [ 168 ] and vascular endothelial dysfunction [ 150 , 169 ] due to their underlying pathophysiology, which may increase the risk of developing PE in pregnancy.…”

“…Hyperinsulinemia can disrupt the usual physiological balance of the RAAS by influencing the activity of regulatory enzymes, receptors, and effector proteins [ 152 , 182 ]. Pre-existing dysregulation of the RAAS may predispose women with PCOS to excessive activation of their RAAS in pregnancy and contribute to the pathophysiology of PE [ 167 , 176 , 177 ].…”

Aldosterone in Gynecology and Its Involvement on the Risk of Hypertension in Pregnancy

“…Genetic, epigenetic, inflammatory, and autoimmune causes have been involved in the pathogenesis. Several predisposing factors have also been reported, such as chronic arterial hypertension, chronic kidney disease, obesity, diabetes, polycystic ovary syndrome (PCOS), endometriosis, familial or personal history of PE (26). Besides placental abnormalities, many studies suggest a possible role of the RAAS in the pathogenesis of PE.…”