ABSTRACT

To understand the association between insulin resistance and hypertensive disorders in pregnancy, we first need to elucidate the role of insulin resistance in hypertensive disorders in the nonpregnant state. The pathogenesis of essential hypertension is multifactorial, involving complex interactions between endocrine, metabolic, and genetic factors. Several other metabolic disturbances, such as elevated levels of triglycerides, decreased levels of high-density lipoproteins, high cholesterol level, glucose intolerance, and hyperuricemia, have also been related to hyperinsulinemia. Insulin resistance impairs glucose tolerance while promoting dyslipidemia, obesity, hypertension, and atherosclerosis. Patients with three or more of these risk factors have an increased incidence of stroke, nephropathy, ischemic heart disease, and peripheral vascular disease. Diabetic pregnancy is associated with a higher rate of hypertensive complications than normal pregnancy and a slightly increased risk of preeclampsia. Patients with the severest form of glucose intolerance are more likely to exhibit preeclampsia than patients with milder forms.