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(Hypertension. 2008;52:394.)
© 2008 American Heart Association, Inc.

Original Articles

A Relationship Between Insulin Sensitivity and Vasodilation in Women With a History of Preeclamptic Pregnancy

Katja H. Lampinen; Mats Rönnback; Per-Henrik Groop; Risto J. Kaaja

From the Department of Obstetrics and Gynecology (K.H.L., R.J.K.), Helsinki University Central Hospital, Helsinki, Finland; Folkhälsan Research Center (K.H.L., M.R., P.-H.G.), Biomedicum, Helsinki, Finland; Department of Medicine (M.R., P.-H.G.), Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland; and the Department of Obstetrics and Gynecology (K.H.L.), Karolinska Institute, Stockholm, Sweden.

Correspondence to Risto J. Kaaja, Helsinki University Hospital, Department of Obstetrics and Gynecology, Haartmaninkatu 2, 00290 Helsinki, Finland. E-mail risto.kaaja{at}helsinki.fi

Women with a history of preeclampsia are characterized by vascular dysfunction and an increased risk of cardiovascular disease. In the present study we investigated whether insulin sensitivity is decreased in women with previous preeclampsia and whether it is associated with endothelium-dependent and/or -independent vasodilation and/or features of metabolic syndrome. Twenty-eight nonobese women with previous severe preeclampsia and 20 women with a previous normotensive pregnancy were studied 5 to 6 years after the index pregnancy. Vasodilation was measured by venous occlusion plethysmography after intra-arterial infusions of sodium nitroprusside and acetylcholine and insulin sensitivity by the intravenous glucose tolerance test using the minimal model technique. The women were tested for lipid profile, inflammatory status and endothelial activation. Insulin sensitivity did not differ between the groups (P=0.24). Insulin sensitivity correlated positively to endothelium-dependent vasodilation only in the patient group in both low (β=0.59; P=0.04) and high (β=0.53; P=0.04) concentrations of acetylcholine and in a high concentration of sodium nitroprusside (β=0.0007; P=0.006). In multivariate analysis, the waist/hip ratio (P=0.04) and serum triglycerides (P=0.04) had the most effect on insulin sensitivity in the patient group. Gestational weeks at the onset of preeclamptic hypertension (P=0.02) and proteinuria (P=0.02) associated positively with insulin sensitivity together with first-trimester body mass index (P=0.008) and maximum diastolic blood pressure during preeclampsia (P=0.005). The present study indicates a relation between insulin sensitivity with vascular dilatory function in women with previous preeclampsia. Furthermore, early onset preeclampsia correlates with impaired insulin sensitivity later in life.

Key Words: preeclampsia • insulin sensitivity • vasodilation • cardiovascular disease • plethysmography • postpartum