Valdés Enrique, Sepúlveda-Martínez Alvaro, Manukián Bárbara, Parra-Cordero Mauro
Fetal Medicine Unit, University of Chile Hospital, Santiago de Chile, Chile.
Gynecol Obstet Invest. 2014;77(2):111-6. doi: 10.1159/000357944. Epub 2014 Jan 25.
To assess the impact that pregestational insulin resistance (PIR) has as a risk factor for preeclampsia (PE).
Nested case-control study that included patients with PIR and a control group that was randomly selected from pregnancies admitted to the Fetal Medicine Unit between January 2005 and May 2011. Clinical and hemodynamic variables were analyzed by a multiple logistic regression analysis.
Of the 13,124 patients admitted during the study period, 119 had a diagnosis of PIR (0.9%). Patients with PIR were older and had a higher body mass index (BMI). PIR was also related to a significantly higher frequency of chronic hypertension (CrHT; 10.1 vs. 2.2%, p < 0.05) and hypothyroidism (5.0 vs. 1.6%, p < 0.05) than in the control group. Moreover, women with PIR were more likely to develop PE (8.4 vs. 4.2%, p < 0.05) and gestational diabetes mellitus (9.2 vs. 2.9%) than the control group. Multivariate analysis showed that maternal age, CrHT and altered uterine artery Doppler sonography during the first and second trimesters were good predictors of PE and that PIR was not.
Although PIR correlates with PE, conditions related to the latter (CrHT, higher maternal age and increased BMI) may be predominant as risk factors for PE.
评估孕前胰岛素抵抗（PIR）作为子痫前期（PE）危险因素的影响。
巢式病例对照研究，纳入患有PIR的患者以及从2005年1月至2011年5月入住胎儿医学科的孕妇中随机选取的对照组。通过多元逻辑回归分析临床和血流动力学变量。
在研究期间收治的13124例患者中，119例被诊断为PIR（0.9%）。患有PIR的患者年龄更大且体重指数（BMI）更高。与对照组相比，PIR还与慢性高血压（CrHT；10.1%对2.2%，p<0.05）和甲状腺功能减退（5.0%对1.6%，p<0.05）的发生率显著更高相关。此外，患有PIR的女性比对照组更易发生PE（8.4%对4.2%，p<0.05）和妊娠期糖尿病（9.2%对2.9%）。多因素分析显示，母亲年龄、CrHT以及孕早期和孕中期子宫动脉多普勒超声异常是PE的良好预测指标，而PIR不是。
尽管PIR与PE相关，但与PE相关的情况（CrHT、母亲年龄较大和BMI增加）可能作为PE的危险因素更为突出。
