Insulin resistance: The possible link between gestational diabetes mellitus and hypertensive disorders of pregnancy

Abstract

Gestational hypertension, preeclampsia, and diabetes are all associated with increased risks of poor maternal and perinatal outcomes. Pregnant women with gestational diabetes have been shown in population studies to have increased risk of pregnancy-associated hypertension compared with nondiabetic women. Moreover, pregnant patients with hypertension are at increased risk for developing gestational diabetes mellitus. It has been hypothesized that this association could be due, at least in part, to insulin resistance. Although insulin resistance is a physiologic phenomenon in normal pregnancy, in predisposed individuals this could lead to hyperinsulinemia with the development of gestational hypertension, gestational diabetes mellitus, or both.

Dopamine D4 receptors inhibit proliferation and migration of vascular smooth muscle cells induced by insulin via down-regulation of insulin receptor expression

“…Insulin resistance and hyperinsulinemia are important risk factors for cardiovascular disease due, in part, to the VSM proliferative and pro-atherogenic actions of insulin [3,5,24,25]. Therefore, reducing the stimulatory effect of insulin on VSMC proliferation and migration may provide new insights in the prevention of atherosclerosis.…”

“…The abnormal proliferation and migration of vascular smooth muscle cells (VSMCs) play a crucial role in neointimal formation and vascular remodeling during atherosclerosis and restenosis [1-3]. It is currently accepted that proliferation and migration of medial VSMCs are involved in neointimal formation after injury, which could be induced by cytokines and growth factors, including insulin.…”

Favorable Effects of Vitamin D Supplementation on Pregnancy Outcomes in Gestational Diabetes: A Double Blind Randomized Controlled Clinical Trial

“…Infants of diabetic mothers are at risk for physiologic, metabolic, and congenital complications such as preterm birth, macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, hypertrophic cardiomyopathy as well as congenital anomalies, particularly of the central nervous system [5]. Women with GDM have higher rates of Cesarean section (CS) [6], are at increased risk of pregnancy-associated hypertension [7] and increased risk of perinatal morbidity and type 2 diabetes in later life [5,8]. …”

Clinical study on the association between pregnancy-induced hypertension and insulin resistance

“…For fetal development and post-natal breastfeeding, the secretion of cytokines (such as leptin, adiponectin, visceral fatty acids and resistin) by adipose tissue increases under the influence of progesterone and placental lactogen, but the ability to synthesize them decreases, so that normal pregnant women present with hyperlipidemia (12)(13)(14)(15). In the present study, serum TC, TG and LDL increased in normal pregnant women, but HDL and apoA-1 decreased, so that each index was maintained at a normal level (16)(17)(18).…”