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Insulin Resistance Increases Gestational Hypertension Risk

Insulin resistance, but not inflammation, independently increases the risk that nulliparous women will develop gestational hypertension.

Researchers from Massachusetts General Hospital and Harvard Medical School, in Boston, Massachusetts, United States, enrolled 51 women who developed gestational hypertension and 102 pregnant women with normal blood pressure. They compared levels of sex hormone-binding globulin (SHBG), a marker of insulin resistance, and C-reactive protein, indicative of inflammation.

Levels of SHBG during the first-trimester were significantly lower in women with gestational hypertension than in controls (176 versus 203 nmol/L; p=0.03). In contrast, levels of C-reactive protein did not differ between patients and controls.

Statistical analysis showed that nulliparity, levels of SHBG during the first-trimester and risk of gestational hypertension were inter-related. Increasing SHBG levels were associated with a declining risk of gestational hypertension among nulliparous women. The odds ratio for developing gestational hypertension was 0.64 for each 50-nmol/L increase in SHBG levels (p<0.01).

After adjusting for confounders, the difference remained significant -- 0.46 for each 50 nmol/L increase (p=0.04). However, no such association emerged among multiparous women.

The authors write that the pathogenesis of gestational hypertension seems to differ between nulliparous and multiparous women.
Hypertension 2002;40:886-91. "Insulin resistance but not inflammation is associated with gestational hypertension."

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