Determinación del índice de resistencia a la insulina mediante homa y su relación con el riesgo de hipertensión inducida por el embarazo

Objective: to assess whether insulin resistance determined by homeostatic model assessment (HOMA) is an early predictor of the development of pregnancy induced hypertension in Colombian pregnant women. Methods: we conducted a nested case control study in a prospective cohort of four hundred and thirty eigth normotensive primigravidae women, with gestational age < 30 weeks. The HOMA was calculated using fasting plasma concentrations of glucose and insulin, determined by glucose-oxidase and chemoluminiscence methods, respectively. Results: twenty-three pregnant women developed pregnancy induced hypertension (5.25%). Two normotensive pregnant women were selected as controls for each case, matched by gestational and maternal age at enrollment. The women who subsequently developed pregnancy induced hypertension had higher levels of HOMA (1.48 ± 0.98 vs 0.96 ± 0.70, p<0.001), which was associated with an increased risk of developing pregnancy induced hypertension (OR: 3.8, IC95%: 1.1-12.8 p=0.01). Systolic blood pressure levels at enrollment were significantly higher in pregnant women who later developed pregnancy induced hypertension (106 ± 12 vs 97 ± 10, p <0.01), showing an interaction with the levels of HOMA in the multiple logistic regression model. Conclusions: women who subsequently developed pregnancy induced hypertension were more insulin-resistant before the onset of clinical manifestations of the disease. The HOMA index could be a useful method to screen women at risk of developing pregnancy induced hypertension.