Revista Colombiana de Cardiología (Jan 2006)
Determinación del índice de resistencia a la insulina mediante homa y su relación con el riesgo de hipertensión inducida por el embarazo Insulin resistance index assessment by homa and its relation with the risk of pregnancy induced hypertension
Abstract
Objetivo: investigar si el grado de resistencia a la insulina determinado por el índice HOMA, predice de manera temprana el desarrollo de hipertensión inducida por el embarazo en gestantes colombianas. Diseño-métodos: se realizó un estudio de casos y controles anidado en una cohorte prospectiva de 438 mujeres primigestantes, normotensas y con edad gestacional menor de 30 semanas. Se determinó el índice HOMA a partir de la medición de glucemia e insulina plasmática en ayunas, por métodos de glucosa oxidasa y quimioluminiscencia, respectivamente. Resultados: veintitrés mujeres desarrollaron hipertensión inducida por el embarazo (5,25%). Se seleccionaron de forma aleatoria dos embarazadas normotensas como controles por cada caso, pareadas por edad materna y gestacional al momento de su inclusión. Las mujeres que posteriormente desarrollaron hipertensión inducida por el embarazo presentaron mayores niveles de HOMA (1,48 ± 0,98 vs. 0,96 ± 0,70, pObjective: 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.
