Martin A, O'Sullivan A J, Brown M A
Department of Renal Medicine, St George Hospital and University of New South Wales, Sydney, Australia.
BJOG. 2001 Dec;108(12):1263-71. doi: 10.1111/j.1471-0528.2001.00289.x.
To determine whether the insulin resistance syndrome and altered body composition are features of hypertensive pregnancy.
Women were recruited in the third trimester of pregnancy from the antenatal clinic, day assessment unit, and maternity ward of St George Hospital, Sydney.
Women with pre-eclampsia (n = 12), gestational hypertension (n = 12), essential hypertension in pregnancy (n = 11), and normotensive pregnancy (n = 10).
Energy metabolism was assessed by indirect calorimetry to measure basal metabolic rate and diet-induced thermogenesis. Body composition was measured as lean body mass, total body water and fat mass by bio-electrical impedance. Blood was collected for measurement of glucose, insulin and lipid profiles. Insulin resistance was indirectly assessed by the insulin and glucose concentrations and diet-induced thermogenesis.
Women with essential hypertension and gestational hypertension were heavier than women with normotensive pregnancies both pre-pregnancy and in the third trimester, whereas women with pre-eclampsia were similar to those with normotensive pregnancy. Women with essential hypertension were otherwise similar to normotensive pregnancy but women with gestational hypertension had a reduced diet-induced thermogenesis and almost double insulin levels. Women with pre-eclampsia had a similar body composition and insulin levels but reduced basal metabolic rate, diet-induced thermogenesis and glucose levels compared with normotensive pregnancy.
Women who develop gestational hypertension, but not pre-eclampsia, are more likely to be overweight. Women with essential hypertension are similar to women with normotensive pregnancy throughout pregnancy. Both gestational hypertension and pre-eclampsia appear to be associated with some degree of insulin resistance, greater than that occurring in normal pregnancy.
确定胰岛素抵抗综合征和身体成分改变是否为妊娠高血压的特征。
从悉尼圣乔治医院的产前诊所、日间评估单元和产科病房招募妊娠晚期妇女。
先兆子痫患者（n = 12）、妊娠高血压患者（n = 12）、妊娠合并原发性高血压患者（n = 11）和血压正常的妊娠妇女（n = 10）。
通过间接测热法评估能量代谢，以测量基础代谢率和饮食诱导产热。通过生物电阻抗测量身体成分，包括去脂体重、总体水和脂肪量。采集血液以测量血糖、胰岛素和血脂谱。通过胰岛素和葡萄糖浓度以及饮食诱导产热间接评估胰岛素抵抗。
原发性高血压和妊娠高血压妇女在孕前和孕晚期均比血压正常的妊娠妇女体重更重，而先兆子痫妇女与血压正常的妊娠妇女相似。原发性高血压妇女在其他方面与血压正常的妊娠妇女相似，但妊娠高血压妇女饮食诱导产热降低，胰岛素水平几乎翻倍。与血压正常的妊娠妇女相比，先兆子痫妇女身体成分和胰岛素水平相似，但基础代谢率、饮食诱导产热和血糖水平降低。
发生妊娠高血压而非先兆子痫的妇女更有可能超重。原发性高血压妇女在整个孕期与血压正常的妊娠妇女相似。妊娠高血压和先兆子痫似乎都与一定程度的胰岛素抵抗有关，且这种抵抗程度大于正常妊娠。
