Determination of insulin resistance using the homeostatic model assessment (HOMA) and its relation with the risk of developing pregnancy-induced hypertension.
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.
Sierra-Laguado
Jesús
J
Vilano Group, Research Institute, Cardiovascular Foundation of Colombia, Floridablanca, Santander, Colombia.
García
Ronald G
RG
Celedón
Johanna
J
Arenas-Mantilla
Mario
M
Pradilla
Lina P
LP
Camacho
Paul A
PA
López-Jaramillo
Patricio
P
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008962:Models, Theoretical; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose; D007328:Insulin