Pregnancy‐induced hypertension and insulin resistance, evidence for a connection

Abstract

PIH, the most common complication of pregnancy, remains a major source of maternal-child morbidity and mortality. Yet the etiology of this disorder is still little understood. There is now a growing body of evidence linking PIH and insulin resistance. Both proteinuric and non-proteinuric PIH predict future essential hypertension, and to a lesser extent, diabetes, disorders strongly related to glucose intolerance and insulin resistance. PIH is associated with diabetes, occurring in up to 50% of diabetic pregnancies. PIH is characterized by the same features that define IRS, including hypertension, dyslipidemia, disruption of endothelial and platelet function and related disturbances of prostanoid synthesis, coagulation and fibrinolytic abnormalities, hyperuricemia, atherosclerotic changes, and obesity. During the last decade, controlled studies by at least 11 different research groups in nine countries have established significant positive associations between both proteinuric and nonproteinuric PIH and various measures of insulin resistance. In particular, prospective investigations by at least five groups of investigators have indicated that relative hyperinsulinemia, glucose intolerance, and insulin insensitivity predict the subsequent development of PIH. These and other studies suggest that insulin resistance may play a causal role in the pathogenesis of PIH, and that some aspects of PIH may represent an early manifestation of IRS, precipitated by the profound metabolic and hemostatic challenges of gestation.

The Incidence of Pregnancy-Induced Hypertension Among Patients With Carbohydrate Intolerance

“…Martinez et al found higher plasma in- sulin levels in women with PIH despite normal glucose tolerance (16). The relationship appears strongest in Caucasians and East Asians (15). This causes secondary hyperinsulinemia.…”

“…Innes and Wimsatt have recently reviewed the extensive evidence for a link between PIH and insulin resistance (15). Innes and Wimsatt have recently reviewed the extensive evidence for a link between PIH and insulin resistance (15).…”

Menopause, the metabolic syndrome, and mind-body therapies

“…Insulin resistance (ie, resistance to insulin-stimulated glucose uptake) is generally considered the primary defect underlying IRS and is a cardinal feature linking IRS with the development of atherosclerosis and CVD 11,20. Insulin resistance is a strong independent risk factor for CVD in both diabetic21 and nondiabetic individuals21–27 and has been causally linked to elevated blood pressure,13,28,30 dyslipidemia,13,31,32 inflammation,19,33 impaired fibrinolysis, 13,19 endothelial dysfunction,13,19,32,34 sympathetic activation, 13,29,34 and other indices of CVD risk 13,18,19. Insulin resistance increases dramatically with menopause,1,6,7,35,36 and is considered to be a key factor underlying the abrupt increase in CVD risk among women after menopause 6,36,37…”

Insulin Resistance Is Associated with Gestational Hypertension and Not with Preeclampsia: A Population-Based Screening Study

“…Patients with gestational diabetes mellitus (GDM) are more insulin resistant compared to control pregnant subjects with NGT [8]. GH has been associated with hyperinsulinemia [2,9,10,11,12,13]. No similar associations were reported regarding the relationship between PE and IR either in normoglycemic pregnancies or in GDM [14,15,16,17,18,19].…”

“…Several studies suggest that glucose intolerance and insulin resistance (IR) may play a role in the etiology of these diseases as the incidence of hypertensive disorders is twice as high in pregnancies of glucose-intolerant women compared to women with normal glucose tolerance (NGT) [2]. IR and related hyperinsulinemia are associated with essential hypertension in nonpregnant individuals [3].…”