RESUMO
OBJECTIVE: To assess whether increased insulin resistance determined by homeostatic model assessment (HOMA) early in pregnancy is associated with the subsequent development of pregnancy-induced hypertension (PIH) in Colombian women with known risk factors. METHODS: We conducted a nested case control study in a prospective cohort of 572 normotensive pregnant women, with gestational age < or = 30 weeks, recruited in Bucaramanga and Floridablanca, Colombia. Fasting plasma glucose and insulin concentrations were determined at enrollment, and HOMA index was calculated. Log-transformed HOMA (log-HOMA) was used in the statistical analysis. Thirty nine PIH cases (18 preeclampsia [PE], 21 gestational hypertension [GH]) were compared to 78 controls, matched by body mass index, gestational and maternal age at enrollment. RESULTS: Women who subsequently developed PIH had higher levels of log-HOMA at enrollment (-0.13 +/- 0.54 v 0.21 +/- 0.60; P = .002), which was significantly associated with the development of PIH (odds ratio 3.13, 95% confidence interval 1.41-6.94; P = .005). Higher log-HOMA was found in women who subsequently developed PE (0.28 +/- 0.58; P = .003), and in those who presented with GH (0.15 +/- 0.62; P = .026). CONCLUSIONS: Women who subsequently develop PIH have a higher degree of insulin resistance determined by log-HOMA early in pregnancy, before the onset of clinical manifestations of the disease. The HOMA seems to be a useful method to evaluate women at risk of developing PIH. More studies are required to confirm its usefulness as a screening tool to identify pregnant women at risk of developing PIH.
Assuntos
Homeostase/fisiologia , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/fisiopatologia , Resistência à Insulina/fisiologia , Modelos Teóricos , Adolescente , Adulto , Glicemia/metabolismo , Estudos de Casos e Controles , Estudos de Coortes , Colômbia/epidemiologia , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Insulina/sangue , Razão de Chances , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Estudos Prospectivos , Fatores de RiscoRESUMO
BACKGROUND: The aim of this study was to investigate whether impaired flow mediated vasodilation precedes the clinical manifestations of preeclampsia and whether is associated with inflammation. METHODS: We conducted a nested case-control study in a prospective cohort of 506 normotensive women recruited before the 30th week of gestation (mean gestational age of 21.8 weeks). At enrollment, flow-mediated dilation was measured in the brachial artery using a 7.5-MHz transducer. C-reactive protein plasma concentrations and leukocyte count were also determined at study entry. Patients were followed until delivery, and medical records were reviewed for each patient to confirm the presence or absence of preeclampsia or gestational hypertension. RESULTS: Of the women studied, 14 developed preeclampsia, 18 developed gestational hypertension, and 474 remained normotensive. Two normotensive pregnant control subjects were randomly selected for each case, matched by maternal age, gestational age, and body mass index at enrollment. Women who subsequently developed preeclampsia had lower flow-mediated dilation (13.4% +/- 4.3% v 18.2% +/- 7.2, P = .026), higher C-reactive protein plasma concentrations (8.7 +/- 5.5 mg/dL v 5.3 +/- 4.3 mg/dL, P = .022) and leukocyte count (10.3 +/- 2.0 x 10(9)/L v 9.1 +/- 2.0 x 10(9)/L, P = .036) at study entry. CONCLUSIONS: Decreased flow-mediated vasodilation and higher levels of CRP are present in early stages of gestation in women who subsequently develop preeclampsia. These alterations occur before the onset of clinical symptoms of PE. Further studies are needed to confirm that flow-mediated dilation and C-reactive protein could be useful methods to screen women at risk of developing preeclampsia.
Assuntos
Proteína C-Reativa/metabolismo , Pré-Eclâmpsia/fisiopatologia , Vasodilatação/fisiologia , Adolescente , Adulto , Artéria Braquial/fisiologia , Estudos de Casos e Controles , Feminino , Humanos , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/etiologia , Gravidez , Estudos ProspectivosRESUMO
Objetivo: investigar si el grado de resistencia a la insulina determinado por el índice HOMA, predice de manera temprana el desarrollo de hipertensión inducida por el embarazo en gestantes colombianas.Diseño-métodos: se realizó un estudio de casos y controles anidado en una cohorte prospectiva de 438 mujeres primigestantes, normotensas y con edad gestacional menor de 30 semanas. Se determinó el índice HOMA a partir de la medición de glucemia e insulina plasmática en ayunas, por métodos de glucosa oxidasa y quimioluminiscencia, respectivamente. Resultados: veintitrés mujeres desarrollaron hipertensión inducida por el embarazo (5,25 porciento). Se seleccionaron de forma aleatoria dos embarazadas normotensas como controles por cada caso, pareadas por edad materna y gestacional al momento de su inclusión. Las mujeres que posteriormente desarrollaron hipertensión inducida por el embarazo presentaron mayores niveles de HOMA (1,48 ± 0,98 vs. 0,96 ± 0,70, p<0,001), lo cual se asoció con un riesgo incrementado de desarrollar la enfermedad (OR: 3,8, IC 95 porciento: 1,1-12,8 p=0,01). Los niveles de presión arterial sistólica al momento de inclusión, fueron significativamente mayores en las mujeres que desarrollaron hipertensión inducida por el embarazo (106 ± 12 vs. 97 ± 10, p <0,01) y se observó una interacción con los niveles de HOMA en el modelo de regresión logística múltiple. Conclusiones: las mujeres que desarrollan hipertensión inducida por el embarazo presentan mayor grado de resistencia a la insulina antes de la aparición de las manifestaciones clínicas características de la enfermedad. El índice HOMA puede constituir un método útil en la detección temprana de riesgo para desarrollar hipertensión inducida por el embarazo en nuestra población.