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(Hypertension. 2006;47:341.)
© 2006 American Heart Association, Inc.

Editorial Commentaries

Insulin Resistance in Preeclampsia

James M. Roberts; Hilary Gammill

From the Magee-Womens Research Institute (J.M.R., H.G.), Pittsburgh, and the Departments of Obstetrics Gynecology and Reproductive Sciences (J.M.R., H.G.) and Epidemiology (J.M.R.), University of Pittsburgh, Pa.

Correspondence to James M. Roberts, MD, Magee Womens Hospital, 204 Craft Ave, Pittsburgh, PA15215. E-mail RSIJMR@mwri.magee.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Hypertension, Parretti and her associates have tested the relationship of insulin resistance to preeclampsia.¹ They make 2 exciting observations. First, insulin resistance is more common in women who are destined to develop preeclampsia months before clinically evident disease. Second, simple assessments of insulin resistance based on a single determination of fasting insulin and glucose can predict preeclampsia at least as well as the current gold standard for prediction of preeclampsia, uterine artery Doppler velocimetry.

Increased insulin resistance is well established to be associated with preeclampsia.² Its relevance as either a risk for preeclampsia or as causally important to its pathophysiology can be questioned. Most studies have not taken into account obesity, which is associated both with increased insulin resistance and with preeclampsia. There is no guarantee that insulin resistance is the mechanism by which obesity increases the risk of preeclampsia. Other relevant pathophysiological consequences of obesity include elevated inflammatory activity,³ altered adipokines,⁴ and higher concentrations of circulating asymmetrical dimethylarginine⁵ (an endogenous inhibitor of NO synthase). In addition, several prior studies have identified insulin resistance only in women with manifest preeclampsia, questioning a cause and effect relationship. Parretti and colleagues avoid both pitfalls. Tests were done in early pregnancy before clinically evident preeclampsia and were limited to lean (body mass index 25) women. Thus, the study supports a direct association of insulin resistance and preeclampsia. Whether the insulin resistance is a component of the pathophysiology or whether it is a preexisting risk factor cannot be answered . . . [Full Text of this Article]

Related Article:

Preeclampsia in Lean Normotensive Normotolerant Pregnant Women Can Be Predicted by Simple Insulin Sensitivity Indexes

Elena Parretti, Annunziata Lapolla, MariaGrazia Dalfrà, Giovanni Pacini, Andrea Mari, Riccardo Cioni, Chiara Marzari, Gianfranco Scarselli, and Giorgio Mello
Hypertension 2006 47: 449-453. [Abstract] [Full Text] [PDF]

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				B. D. LaMarca, J. Gilbert, and J. P. Granger Recent Progress Toward the Understanding of the Pathophysiology of Hypertension During Preeclampsia Hypertension, April 1, 2008; 51(4): 982 - 988. [Full Text] [PDF]