Insulin,insulin-like growth factor-1, and insulin resistance in women with pregnancy-induced hypertension

OBJECTIVE: The purpose of this study was to assess insulin, insulin sensitivity, and insulin-like growth factor-I in women with preeclampsia and gestational hypertension. STUDY DESIGN: Insulin resistance was measured with the short insulin-tolerance test in 20 women with preeclampsia, in 18 women with gestational hypertension, and in 20 normotensive control subjects. Sex hormone binding globulin, insulin-like growth factor-I, glucose, fructosamine, glycosylated hemoglobin, insulin, C-peptide, and lipids were measured in the fasting state. RESULTS: Women with gestational hypertension had a significant lower insulin sensitivity index (0.13 +/- 0.1) and a higher level of insulin-like growth factor-I (333.71 +/- 107.6 ng/mL) than women in the control group (0.21 +/- 0.1 [P <.05]; 218.11 +/- 82.3 ng/mL [P <.01]) and women with preeclampsia (0.21 +/- 0.12 [P <.05]; 234.78 +/- 92.76 ng/mL [P <.01]). There were no significant correlations between insulin sensitivity index and insulin-like growth factor-I. CONCLUSION: Insulin resistance is present in women with gestational hypertension but not in women with preeclampsia and did not correlate with insulin-like growth factor-I.     

Evaluation of natural coagulation inhibitor levels in various hypertensive states of pregnancy

OBJECTIVE: To evaluate the role of natural coagulation inhibitors in various classifications of pregnancy associated hypertension in Turkish population living in Trakya region of Turkey. STUDY DESIGN: Serum uric acid levels, plasma protein C (PC), protein S (PS), antithrombin III (AT III) activities and activated protein C resistance (APCR) were measured in 80 pregnant women with hypertension (preeclampsia, n = 32; severe preeclampsia, n = 25; eclampsia, n = 14; chronic hypertension, n = 9) and 58 healthy pregnant women. Tukey and Tamhane multiple comparison tests, Kruskal-Wallis, chi2 and Fisher's exact tests were performed for comparison of means and/or medians. RESULTS: Serum uric acid levels were significantly elevated in women with preeclampsia and severe preeclampsia, but PS activity decreased in women with severe preeclampsia (33.2 +/- 18.9% versus 50.4 +/- 22.7%, p = 0.015) and chronic hypertension (29.5 +/- 14.5% versus 50.4+ /- 22.7%, p = 0.045) compared to healthy controls. There was no significant difference in APCR, and PC or AT III activity between the groups. Platelet counts were significantly lower in women with severe preeclampsia, compared to controls and women with chronic hypertension. CONCLUSION(S): Serum uric acid levels and plasma protein S activity may be useful as indices of severity of pathology in pregnancy associated hypertension.     

Sex hormone-binding globulin in gestational diabetes

BACKGROUND: Insulin is an important regulator of serum sex hormone-binding globulin (SHBG) concentration which works by inhibiting its production in hepatocytes. Low SHBG level is associated with increased insulin resistance and hyperinsulinemia. Our purpose was to compare maternal serum SHBG level between normal and gestational diabetic pregnant women and to study the relationships between SHBG, SHBG/insulin and SHBG/glucose ratio and several endocrine, metabolic and clinical parameters. METHODS: Serum SHBG concentrations were measured in 34 women with gestational diabetes and in 32 matched controls. Glucose, insulin, C-peptide, fructosamine, beta-HCG, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, total and free T4, total and free estriol, T3 and IGF-1 were measured. Insulin sensitivity was estimated using the short insulin tolerance test. RESULTS: SHBG, SHBG/insulinemia ratio and SHBG/glucose ratio were significantly lower in the diabetic group (309.54 +/- 112.22 vs 460.54 +/- 144.54, p = 0.00001), (33.55 +/- 16.62 vs 72.56 +/- 66.50, p = 0.0006 using log-transformed values), (5.88 +/- 1.87 vs 3.39 +/- 1.23, p < 0.00001). SHBG was negatively correlated with insulinemia (r = -0.40, p = 0.001), C-peptide (r = -0.41, p = 0.001), glycemia (r = -0.27, p = 0.02), diastolic blood pressure (r = -0.41, p = 0.001) and beta-HCG (r = -0.41, p = 0.001) and positively correlated with LDL-c (r = 0.25, p = 0.04) and apolipoprotein B (r = 0.33, p = 0.007). CONCLUSIONS: SHBG concentrations are lower in gestational diabetic pregnant women and are related to insulin levels but not to peripheral insulin sensitivity. Since insulinemia was similar in normal and gestational diabetic pregnant women, we speculate that gestational diabetes is characterized by a higher peripheral insulin resistance, a fasting normal insulinemia and a higher hepatic insulin sensitivity, at least in other actions than on carbohydrate metabolism. The role of sex steroids, T4 and IGF-1 in regulating SHBG appears to be limited during pregnancy.     

Relation between serum uric acid and plasma adenosine levels in women with preeclampsia

The aim of this study was to examine the relationship between plasma adenosine and serum uric acid levels in women with preeclampsia. Maternal arterial blood sampling was performed to measure serum uric acid and plasma adenosine levels in 20 pregnant women complicated by preeclampsia and 22 normal pregnant women at 33-38 weeks of gestation. The average plasma adenosine levels were 0.31 +/- 0.12 micromol/l in the normal pregnant group and 0.45 +/- 0.11 micromol/l in the preeclampsia group. The mean serum uric acid level in women with preeclampsia was 5.9 +/- 0.60 mg/dl, significantly higher than in the normal pregnant women (4.4 +/- 0.69 mg/dl). Positive correlations were found between serum uric acid and plasma adenosine levels in both the group with (r(2) = 0.38, p < 0.05) and the group without (r(2) = 0.54, p < 0.05) preeclampsia. There was also a significant correlation between serum uric acid and plasma adenosine levels on the whole (r(2) = 0.59, p < 0.05). Our results suggest that increased adenosine is a contributing source of preeclamptic hyperuricemia.     

Carbohydrate metabolism in gestational diabetes: effect of chronic hypertension.

OBJECTIVE: To evaluate whether the coexistence of chronic hypertension and gestational diabetes mellitus (GDM) is characterized by a greater impairment of carbohydrate metabolism than GDM alone. METHODS: Carbohydrate metabolism of eight women with chronic hypertensive GDM and 15 normotensive women with GDM was evaluated in the third trimester using the oral glucose tolerance test (GTT) and hyperinsulinemic-euglycemic clamp technique. Controls were ten normotensive, glucose-tolerant, pregnant women in the third trimester. RESULTS: Insulin sensitivity of women with chronic hypertension and GDM was approximately twofold lower than those with GDM only (1.54+/-0.35 versus 4.15+/-0.31, P < .001) and approximately fivefold lower than controls (1.54+/-0.35 versus 7.65+/-0.66, P < .001). Women with chronic hypertension and concomitant GDM had higher insulin levels in response to GTT than controls (P < .001 repeated measures analysis of variance). In all subjects, mean arterial pressure (MAP) had a strong negative correlation with maternal insulin sensitivity (r = -0.62, P < .001). Significant correlation was also found between percent of body fat and insulin sensitivity (r = -0.53, P < .002). Those regressions were still significant when adjusted for percent of body fat and MAP. CONCLUSION: Gravidas with chronic hypertension and GDM are more insulin resistant than those with GDM alone. Blood pressure, in a population of pregnant women with normal and abnormal carbohydrate metabolism, is a stronger predictor of insulin resistance than adiposity.     

子痫前期和正常妊娠代谢综合征变量的对比

目的:研究妊娠期高血压疾病中代谢综合征变量的发生情况。方法:前瞻性对比年龄、孕周、产次相匹配的65例妊娠期高血压,60例子痫前期,30例子痫及33例正常妊娠孕妇的各项指标。主要测量指标包括血压、血脂、血糖及尿酸水平。结果:患者年龄19～40岁,平均28.5±4.6岁;妊娠期高血压,子痫前期和子痫患者的血压较对照组明显增加(收缩压P0.01;舒张压P0.01);子痫前期组和子痫组的血浆总胆固醇、甘油三酯、血糖和尿酸均明显高于妊娠期高血压组及对照组(P0.05);妊娠期高血压组、子痫前期组及子痫组代谢综合征的发生率分别为13.8%、23.3%及26.7%。结论:妊娠期高血压疾病患者有代谢综合征的标志,推断两种情况相互关联。     

Maternal serum nitric oxide levels associated with biochemical and clinical parameters in hypertension in pregnancy

OBJECTIVES: To measure maternal serum concentrations of total nitrites, as an index of nitric oxide synthesis, in normal and hypertensive pregnant women, and to examine the correlation between these concentrations and several variables of clinical interest. STUDY DESIGN: A total of 60 women in four different groups were studied: 10 normotensive pregnant women, 17 pregnant women with preeclampsia, 18 pregnant women with gestational hypertension and 15 pregnant women with chronic hypertension. Serum nitrite levels were determined using the Griess reaction after reduction with nitrate reductase. RESULTS: Serum nitrite levels were higher in preeclamptic women (34.11+/-14 micromol/l, P=0.04), lower in chronic hypertensive women (19.56+/-6.46 micromol/l, P=0.04) and similar in women with gestational hypertension (26.97+/-9.44 micromol/l) in comparison to the control group (25.37+/-7.24 micromol/l). Serum nitrite levels in preeclamptic women had significant positive correlations with hematocrit, fasting insulinemia, and apolipoprotein B and negative correlations with platelet count, serum phosphorus and glucose:insulin ratio. In pregnant women with chronic hypertension a negative correlation was found between serum nitrite levels and active partial thromboplastin time. In pregnant women with gestational hypertension, serum nitrite levels had negative correlations with birthweight and 24-h urine calcium, and positive correlations with mean corspuscular hemoglobin, 24-h urine sodium and maternal age. CONCLUSIONS: We suggest that in women with preeclampsia, a higher maternal nitric oxide level may act as a compensatory mechanism against hemoconcentration and platelet aggregation and that nitric oxide production may be related to some metabolic events. In women with gestational hypertension, higher serum nitrite levels may be related to clinical and biochemical findings common in preeclampsia. In chronic hypertension, a lower maternal nitric oxide level is related to the status of coagulation.     

Low plasma levels of oxidized low density lipoprotein in preeclampsia

BACKGROUND: Markers of lipid peroxidation are commonly used to assess oxidative stress in preeclampsia. The aim of this study was to assess the concentration of oxidized low density lipoprotein (oxLDL), a novel marker for lipid peroxidation, and that of the thiobarbituric acid reactive substances (TBARS) in the pathogenesis of severe preeclampsia and to investigate the influence of gestational age on these parameters. METHOD: Plasma levels of oxLDL and TBARS were assayed in women with severe preeclampsia (n = 40), normotensive pregnant controls matched for gestational age (n = 24) and normotensive pregnant controls at full term (n = 16). RESULTS: Women with preeclampsia showed lower oxLDL levels (mean +/- SE) than matched controls (181 +/- 12 vs. 219 +/- 14; p = 0.027), whereas no differences were found for the TBARS concentration (3.8 +/- 0.6 vs. 3.7 +/- 0.4). When women with preeclampsia were compared to control women at full term, TBARS were elevated (3.8 +/- 0.6 vs. 1.5 +/- 0.2; p = 0.01). However, in women with normotensive pregnancy TBARS were also lower in full-term control pregnancy compared to early third-trimester values (p < 0.0001). CONCLUSION: Plasma TBARS decreased during the third trimester of pregnancy, underlining the importance of matching for gestational age when studying markers of lipid peroxidation in pregnant women. Women with preeclampsia had lower plasma levels of oxLDL compared to gestational age-matched controls, indicating that oxLDL could be a marker for preeclampsia.     

Serum leptin levels in hypertensive disorder of pregnancy

OBJECTIVE: To determine serum leptin levels in hypertensive disorder of pregnancy. MATERIALS AND METHODS: In this prospective, cross-sectional, case control study, we measured serum leptin levels of 58 hypertensive pregnant women and 54 normal pregnant women. We also did blood and urine analysis for the evaluation of the severity of hypertensive disorder of pregnancy. The patients were followed until after delivery and information about labour was recorded. We analysed the difference and correlation between anthropometric measures, hormonal and biochemical parameters, and serum leptin levels in two groups. RESULTS: In the study group, serum leptin levels were determined to be higher than the control group. Neonatal birth weight was significantly lower in the hypertensive group. While the serum uric acid, urea, aspartate aminotransferase, fibronectin, and fasting blood glucose levels were found to be higher, serum total protein and albumin levels were significantly lower among the hypertensive pregnant women. Hypertensive pregnant women were more insulin resistant. Serum leptin levels were highly and positively correlated with serum fibronectin, and C peptide levels. A negative significant correlation was observed between maternal serum leptin levels and neonatal birth weight among the pregnant women having the hypertensive disorders. CONCLUSION: Serum leptin levels in hypertensive pregnant women appear to be higher. The determination of serum leptin levels may be as important as serum fibronectin and C peptide levels in the management of hypertensive disorder of pregnancy. C peptide and insulin may be due to hyperinsulinemia which leads to increased stimulation of leptin production by fatty tissue. Insulin resistance which appears in late pregnancy is more significant especially in pregnancies complicated by preeclampsia.     

Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia

OBJECTIVE: To study the plasma levels of homocysteine in preeclampsia and relate them to insulin sensitivity. METHODS: In association with a 3-hour intravenous glucose-tolerance test (glucose 0.3 g/kg at 0 and 0.03 IU insulin 20 minutes later), we measured plasma levels of homocysteine, vitamin B12, and folic acid in 22 women with preeclampsia and 16 controls between 29 and 39 weeks' gestation. In 14 women with preeclampsia and 11 controls, plasma samples also were collected 3 months after delivery. RESULTS: Levels of homocysteine in women with preeclampsia (6.7 +/- 0.4 micromol/L, mean +/- standard error) were higher (P < .001) than those in controls (3.8 +/- 0.2 micromol/L) and related significantly to the level of proteinuria (r = .49, P = .02). Vitamin B12 concentrations were lower in women with preeclampsia (166.0 +/- 10.4 compared with 212.4 +/- 16.4 pmol/L, P = .02), whereas levels of folic acid showed no difference between the groups. After delivery, levels of homocysteine increased to 9.1 +/- 0.6 and 8.2 +/- 0.6 micromol/L in women with preeclampsia and controls, vitamin B12 increased to 298.8 +/- 28.6 compared with 334.9 +/- 24.0 pmol/l, and folic acid decreased to 10.6 +/- 2.0 compared with 7.9 +/- 0.8 nmol/L, with no difference emerging between the groups. In women with preeclampsia but not in controls, plasma homocysteine was negatively related to insulin sensitivity (r = -.51, P = .02). The mean 2.9-fold increase in glucose or 52.5-fold increase in insulin during the insulin-sensitivity test failed to affect homocysteine levels. CONCLUSION: Women with preeclampsia have high plasma homocysteine levels that are inversely related to insulin sensitivity.     

Plasma endothelin levels in preeclampsia: elevation and correlation with uric acid levels and renal impairment.

OBJECTIVE: The purpose of this study was to determine if endothelin levels are elevated in women with preeclampsia and if these levels correlated with other laboratory features of disease severity. STUDY DESIGN: Parameters were compared in four groups of women volunteers by means of analysis of variance: (1) 16 women with preeclamptic pregnancies, (2) 11 pregnant women without preeclampsia, of similar lengths of gestation, (3) six otherwise normal women with pregnancies at term or beyond (greater than 38 weeks), and (4) 22 normotensive young women. RESULTS: Endothelin levels were elevated in women with preeclampsia as compared with those of gestation-matched pregnant and nonpregnant controls (22.6 +/- 2.0 vs 12.0 +/- 1.0 vs 10.4 +/- 1.3 pmol/L, p less than 0.005, preeclampsia vs controls) and also were increased in late gestation (17.7 +/- 2.0 pmol/L). Endothelin correlated positively with plasma levels of uric acid (r = 0.698, p less than 0.005) and inversely with creatinine clearance (r = -0.659, p less than 0.05). CONCLUSION: Circulating endothelin levels are elevated in women with preeclampsia and correlate closely with serum uric acid levels and measures of renal dysfunction. These observations suggest that endothelin may contribute to renal vasoconstriction in preeclampsia.     

Peripheral blood concentrations of adiponectin, an adipocyte-specific plasma protein, in normal pregnancy and preeclampsia

Insulin resistance increases during the normal course of pregnancy, and is considered an important cause of complications including gestational diabetes mellitus, pregnancy-induced hypertension and preeclampsia (PE). Adiponectin, an adipocyte-specific plasma protein, is thought to enhance insulin sensitivity; another adipocytokine, leptin, also is thought to promote insulin sensitivity. We determined peripheral blood concentrations of adiponectin and leptin in 40 healthy nonpregnant women with a body mass index (BMI)<25, 40 healthy pregnant women with prepregnancy BMI<25, and 15 PE patients with prepregnancy BMI<25. Serum adiponectin concentrations were lower in the healthy pregnant group than in the nonpregnant group (9.40+/-4.43 versus 13.15+/-6.69 microg/mL, p<0.01), but difference disappeared after correction for haematocrit. Serum leptin concentrations were high in the normal pregnant group after correction for haematocrit (10.08+/-6.58 versus 6.24+/-3.61 ng/mL, p<0.05). Corrected after haematocrit, serum adiponectin in PE patients was higher than healthy pregnant women at 28 to 40 gestational weeks (17.46+/-11.81 versus 9.33+/-4.47 microg/mL, p<0.01). Leptin in PE was higher than in the normal pregnant group (21.15+/-19.89 versus 11.77+/-6.25 ng/mL, p<0.05), also after correction for haematocrit. These results suggested a metabolic shift in normal pregnant women and PE patients mediated through adipocytokines.     

妊娠期高血压疾病患者胎盘组织中血管活性肽Apelin的表达及其意义

目的 探讨妊娠期高血压疾病患者胎盘组织中血管活性肽Apelin的表达及其意义。方法 选择妊娠期高血压疾病患者36例（妊娠期高血压疾病组）,其中妊娠期高血压10例,轻度子痫前期11例,重度子痫前期15例;选择同期正常产妇15例作为正常妊娠组。采用免疫组化染色法及实时荧光定量RT-PCR分别检测两组产妇胎盘组织中Apelin-36及ApelinmRNA的表达。结果 正常妊娠组Apelin-36及ApelinmRNA分别为0．27±0．04及0．82±0．25,妊娠期高血压疾病组分别为0．18±0．05及0．31±0．21,两组比较,差异有统计学意义（P〈0．01）;其中,妊娠期高血压患者分别为0．24±0．02及0．59±0．16,轻度子痫前期患者分别为0．16±0．03及0．25±0．07,重度子痫前期患者分别为0．14±0．02及0．17±0．09,轻度、重度子痫前期患者的Apelin-36及ApelinmRNA表达水平均低于妊娠期高血压患者（P〈0．01,P〈0．01）,轻度子痫前期患者与重度子痫前期患者比较,差异也有统计学意义（P〈0．05,P〈0．05）。结论 血管活性肽Apelin在胎盘组织中表达降低,可能与妊娠期高血压疾病的发生、发展有关。     

妊娠期糖尿病孕妇血清肿瘤坏死因子α水平变化与胰岛素抵抗关系的研究

目的　探讨妊娠期糖尿病孕妇血清肿瘤坏死因子α(TNF α)水平变化与胰岛素抵抗的关系。方法　采用酶联免疫吸附试验测定 4 2例妊娠期糖尿病孕妇 (GDM组 )、4 0例正常妊娠晚期孕妇 (正常妊娠组 )空腹血清TNF α水平 ;同时测定两组孕妇空腹血糖、C肽、胰岛素、糖化血红蛋白(HbA1c)水平。并且根据公式计算两组孕妇的胰岛素敏感指数 (ISI) ,以评价胰岛素抵抗程度。结果(1)GDM组孕妇空腹血清TNF α水平为 (5 2± 1 6 )ng/L ,正常妊娠组孕妇为 (4 5± 0 5 )ng/L ,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇ISI为 - 4 3± 0 4 ,正常妊娠组为 - 3 8± 0 3,两组比较 ,差异有极显著性 (P <0 0 1)。 (2 )GDM组孕妇空腹血糖、胰岛素、C肽水平分别为 (5 5± 0 7)mmol/L、(13 4± 3 8)mU/L、(1 6± 0 4 )nmol/L ,正常妊娠组孕妇空腹血糖、胰岛素、C肽水平分别为(4 9± 0 4 )mmol/L、(9 3± 2 5 )mU/L、(1 2± 0 3)nmol,两组比较 ,差异有极显著性 (P <0 0 1) ;GDM组孕妇HbA1c为 (5 6± 0 5 ) % ,正常妊娠组孕妇为 (5 3± 0 5 ) % ,两组比较 ,差异有显著性(P <0 0 5 )。 (3)GDM组孕妇空腹血清TNF α水平与ISI呈显著负相关 (r=- 0 70 3,P <0 0 1) ,分别与空腹血糖、C肽、HbA1c呈显著正相关 (r     

The prevalence of non-classic adrenal hyperplasia among Turkish women with hyperandrogenism

Insulin resistance in late pregnancy increases nutrition availability in maternal circulation. Moreover, it is the leading cause of oxidative stress in pregnant women. Herein, we aimed to define the correlation between insulin resistance, serum inducible nitric oxide (iNOS) and serum lipid levels in patients with intrauterine growth retardation (IUGR) pregnancies and controls. We performed a cross sectional study of IUGR pregnancies uncomplicated with preeclampsia as cases and age, body mass index, parity and gestational age matched pregnant women as controls. We quantified serum insulin, fasting blood sugar (FBS), iNOS and lipid profile of the cases and controls. Serum total cholesterol and LDL-C were significantly lower when serum iNOS, FBS, insulin and homeostasis model assessment of insulin resistance (HOMA-IR) levels were significantly higher in patients with IUGR pregnancies. There was not any significant difference in serum iNOS levels between patients and controls (12.4?±?2.1 vs. 11.1?±?1.9; p?=?0.52) after multiple adjustment for HOMA-IR. Serum iNOS levels were significantly correlated with maternal serum insulin, triglyceride and HOMA-IR levels in patients with IUGR pregnancies when there was not such a correlation in controls. We showed a positive correlation between insulin resistance and markers of oxidative stress like iNOS in IUGR pregnancies.     

Serum adiponectin levels in normal and hypertensive pregnancy.

OBJECTIVE: The aim of this study was to quantify adiponectin levels in women with normal and hypertensive pregnancies to determine whether there is an independent association, while controlling for body fat and insulin sensitivity. METHODS: A cross-sectional study was conducted in the following categories: 12 normotensive non-pregnant women, 10 normotensive, 12 gestational hypertensive, 13 essential hypertensive, and 12 preeclamptic women. All subjects underwent measurements of body fat by bio-impedance analysis and blood sampling. RESULTS: Percentage of body fat and insulin resistance were greater in all pregnant groups compared with non-pregnant women. Adiponectin concentrations were significantly lower in women with normal pregnancies (18.6 +/- 1.4 microg/mL, p = 0.02) compared with non-pregnant women (24.0 +/- 1.5 microg/mL). However, adiponectin levels were not significantly different among normal pregnancy, gestational hypertension (19.0 +/- 3.1 microg/mL), essential hypertension (24.0 +/- 3.7 microg/mL) and pre-eclampsia (22.4 +/- 2.5 microg/mL) groups. Adiponectin levels were inversely related to percent body fat and insulin resistance. When adiponectin levels were corrected for percent body fat and insulin resistance, no significant differences were seen among the study groups. CONCLUSIONS: Adiponectin levels are decreased in normal pregnancy, however this difference disappears when adiponectin levels are corrected for the pregnancy-related increases in body fat and insulin resistance. Adiponectin levels are not altered significantly in states of hypertension in pregnancy compared with normal pregnancy.     

No association between insulin resistance and preeclampsia.

OBJECTIVE: To investigate the possible link between insulin resistance and preeclampsia. METHODS: The study included 30 primigravidas between 28 and 34 weeks of gestation. The study subjects were divided into two groups: Group A consisted of 15 normotensive women of a mean gestational age of 31.6 weeks and group B consisted of 15 preeclamptic women of a mean gestational age of 29.9 weeks. Glucose and insulin levels were measured at 0, 1 and 2 h of an OGTT (after 75 g oral glucose administration). Insulin resistance and sensitivity were evaluated with the use of IR HOMA, QUICKI and IS OGTT. RESULTS: Glucose and insulin levels at 0, 1 and 2 h of the OGTT as well as IR HOMA, QUICKI and IS OGTT were comparable between preeclamptic and normotensive pregnant women. CONCLUSIONS: Our results indicate that preeclampsia is not associated with hyperinsulinaemia and/or insulin resistance, in either the fasting or the postprandial state.     

Calciuria and preeclampsia: a case-control study

OBJECTIVE: The aim of this study was to compare calciuria of preeclamptic cases to normotensive controls among pregnant women hospitalized in the French West Indies obstetrics department. STUDY DESIGN: This case-control study included 47 preeclamptic women and 50 controls. The main outcome was 24h urinary calcium excretion rate. Serum levels of creatinine, calcium and uric acid were also analyzed. A logistic regression analysis has been performed to investigate the relationship between hypocalciuria and preeclampsia after having taken into account prognostic preeclampsia factors and pertinent clinical criteria. RESULTS: Women with preeclampsia had significantly lower calciuria than normotensive patients (1.5 mmol/24h+/-1.0 versus 6.0 mmol/24h+/-4.2, p=0.0001). After taking into account gestational age at hospitalization, body mass index and nulliparity, hypocalciuria was significantly associated with preeclampsia (ORa=21.74; 95% CI, 6.9-66.7). The diagnosis value of a calciuria less than 2.1 mmol/24h is interesting because of its negative predictive value (97%), but its positive predictive value is weak (42%). CONCLUSION: In our population, preeclamptic women had a calciuria significantly lower than controls.     

Effects of ethnicity on glucose tolerance, insulin resistance and beta cell function in 223 women with an abnormal glucose challenge test during pregnancy

This study was conducted to investigate body-mass-index (BMI), insulin resistance and beta cell function in a group of pregnant women. Two hundred and twenty-three consecutive women with an abnormal 50 g glucose challenge test in the third trimester were studied. All underwent oral glucose tolerance testing; 97 had a 100 g test and 126 a 75 g test. Fasting insulin was measured. Insulin resistance and beta cell function were calculated using the homeostasis model. Among the 136 Caucasian, 60 Asian, 11 Indian and 16 Arabic women studied, there were no age differences. Arabic women had higher parity (p < 0.05). Asian women had lower BMI than Caucasian (p < 0.001), Indian (p < 0.01), and Arabic women (p < 0.01). Women with gestational diabetes had higher insulin resistance than women with normal glucose tolerance (2.9+/-4.0 vs. 2.3 +/- 2.5 p = 0.025). Women with gestational diabetes tended to have lower beta cell function 199 +/- 203 vs. 247 +/-380 p = 0.08). Asian women had higher glucose levels than Caucasian women after 50 g challenge (8.9 +/- 2.1 mmol/1 vs. 8.6 +/- 1.6; p = 0.034). Asian women were more likely to have gestational diabetes than Caucasian women (31.7% vs. 14%; p = 0.02). Fasting glucose and insulin were comparable in Asian and Caucasian women. Mean insulin resistance and beta cell function in Asian and Caucasian women were not significantly different. We concluded that Asian women had lower BMI than Caucasian women. Women with gestational diabetes were more insulin resistant. Insulin resistance and beta cell function in Asian and Caucasian women are similar. Gestational diabetes in Asian women is of similar aetiology to that seen in Caucasian women, but occurs at a lower BMI.     

Accelerated starvation in late pregnancy: a comparison between obese women with and without gestational diabetes mellitus

We compared the glucose, insulin, free fatty acid, and 3-hydroxybutyrate responses to a briefly extended overnight fast during the third trimester of pregnancy between two groups: obese women with normal glucose tolerance (n = 10) and age- and weight-matched women with gestational diabetes mellitus (n = 10). After a 12-hour overnight fast, plasma glucose (95 +/- 4 vs. 78 +/- 2 mg/dl; p less than 0.01), insulin (32 +/- 5 vs. 17 +/- 2 microU/ml; p less than 0.02), and free fatty acid (860 +/- 63 vs. 639 +/- 79 mmol/L; p less than 0.05) levels were higher in the patients with gestational diabetes mellitus. 3-Hydroxybutyrate levels were similar in the two groups at that time (0.23 +/- 0.04 vs. 0.18 +/- 0.03 mmol/L; p greater than 0.3). When the fast was extended to 18 hours by having the patients skip breakfast, glucose levels fell more rapidly in the group with gestational diabetes mellitus but remained elevated compared with the nondiabetic women. Insulin levels declined at a similar rate in the two groups. Free fatty acid levels did not increase significantly in the group with gestational diabetes mellitus during the extended fast. In contrast, free fatty acid levels increased by 44% in the normal pregnant women, reaching the level observed in the group with gestational diabetes mellitus after 18 hours. 3-Hydroxybutyrate levels remained virtually identical in the two groups throughout the brief fast. Thus, compared with that of normal pregnant women, the response of obese women with gestational diabetes mellitus to brief caloric deprivation during late pregnancy was characterized by a greater fall in plasma glucose values without a greater propensity to ketosis. Our findings may have important implications for the dietary management of obese patients with gestational diabetes mellitus.