The importance of pathological insulin resistance and hyperinsulinemia in the pathogenesis of preeclampsia

Abstract

Aim : to assess dynamic changes in insulin resistance (IR), hyperinsulinemia (HI) and related parameters of carbohydrate and lipid metabolism, endothelial dysfunction, pro-inflammatory and prothrombotic states in pregnancy complicated with preeclampsia (PE). Materials and Methods . A prospective observational study was conducted consisting of laboratory monitoring 148 high-PE-risk pregnant women comprising Group I - 72 women with overt PE; 36 healthy women with physiological course of pregnancy were included into Group II. All women were assessed level of venous blood glucose, insulin, total cholesterol, high-density lipoproteins (HDL), triglycerides (TG), leptin, placental lactogen, uric acid, tumor necrosis factor-a, C-reactive protein, circulating endothelial cells, fibronectin, nitric oxide metabolites, platelet aggregation at gestational periods 11-14 weeks, 18-21 weeks and 30-34 weeks. We also calculated insulin resistance index, atherogenic coefficient, and TG/HDL ratio, estimating accumulation and distribution of adipose tissue. Results . There were found physiological changes in IR and HI, lipid, endothelial-hemostasis axis, pro-inflammatory, placental parameters supposed to provide proper fetal energy supply during normal pregnancy. During PE, these parameters were aberrantly elevated starting from early pregnancy stage due to failure of gestational adaptation mechanisms, which acquire important pathogenetic significance therein. Conclusion . A holistic view at the mechanisms of forming atherogenic transformation of the lipid profile, endothelial dysfunction, pro-inflammatory and prothrombotic status, oxidative stress, hyperuricemia, visceral type of abdominal wall fat deposition as well as correlation analysis data indicate that all such changes were associated with unified pathogenetic arm consisting of pathological IR and HI serving as early baseline mechanisms in PE development.