Carbohydrate metabolism. Evaluation in women with de novo hypertension in late pregnancy.

OBJECTIVE

To evaluate carbohydrate metabolism in both diabetic and nondiabetic women with de novo hypertension in late pregnancy.

STUDY DESIGN

Sixty-nine nondiabetic pregnant women were studied: 33 with gestational hypertension, 15 with preeclampsia and 21 normotensives in the control group. Eight women with gestational diabetes and hypertension were evaluated separately. Glucose and insulin serum levels were evaluated in the fasting state and during an oral glucose load. Glucose-independent parameters were used to evaluate insulin response, insulin activity and glucose tolerance in fasting and postglucose ingestion states. Student's t test was used.

RESULTS

Fasting glycemia was lower in both groups with de novo hypertension in late pregnancy than in the control group. Glycemia was higher throughout the oral glucose load in gestational hypertension than in preeclampsia. Insulinemia during the oral glucose load was higher in gestational hypertension than in both the control and preeclampsia groups. Fasting corrected insulin response and glucose tolerance were higher in gestational hypertension and preeclampsia than in the control group. In the postglucose ingestion state, insulin activity and glucose tolerance was lower in gestational hypertension than in preeclampsia. Women with gestational diabetes and hypertension were very insulin resistant.

CONCLUSION

Glucose tolerance was not only decreased but also increased in the fasting state in de novo hypertension in late pregnancy due to a high insulin response. In the postglucose ingestion state, the gestational hypertension trend was toward insulin resistance even though normal insulin activity occurs in preeclampsia. Gestational diabetes associated with gestational hypertension was characterized by high insulin resistance.