Preeclampsia as a separate gestational clinical and pathogenetic form of insulin resistance syndrome

Objective: To develop the concept of preeclampsia based on the similar clinical and laboratory features of preeclampsia and insulin resistance syndrome (IRS). Materials and methods: This prospective study included 292 pregnant women retrospectively divided into four groups. Group 1 comprised 89 high-risk women with preeclampsia, Group 2 consisted of 50 women with IRS and preeclampsia, Group 3 consisted of 32 pregnant women with IRS without preeclampsia, Group 4 (control group) included 30 pregnant women with a healthy pregnancy. The examination was conducted at weeks 11-14, 18-21, and 30-34 of pregnancy and the onset of preeclampsia. Results: There was a similarity of clinical manifestations of preeclampsia and IRS in the form of arterial hypertension, proteinuria/microalbuminuria, abnormal diurnal blood pressure pattern, gestational /obstructive sleep apnea syndrome, abdominal visceral adipose tissue accumulation and insomnia. There were no significant differences in the incidence of preeclampsia at different times of its onset and severity in the high-risk group without somatic pathology (49.4%) and the group with IRS (61.0%) [x2=2.56, p=0.11]. Preeclampsia and IRS had common underlying mechanisms, characterized by an increase in pathological IR and hyperinsulinemia (HI) from the early stages of pregnancy and associated with them dyslipidemia, leptinemia, uricemia, abdominal visceral adipose tissue accumulation, inflammatory state, endothelial and hemostasis disorders, due to disruption of gestational adaptation to placental anti-insulin factors that provide stable fetal nutritional and energy supply. The time of preeclampsia onset is determined by processes associated with pathological IR, HI, and alteration in the fetal-placental unit. Conclusion: Comprehensive evaluation of pregnant women with preeclampsia and without somatic comorbidities, with preeclampsia and IRS, and with an uncomplicated pregnancy allowed for creating a scientific concept of preeclampsia development, according to which preeclampsia is considered as a separate gestational clinical and pathogenetic form of IRS, which defines the prospect of the prediction and prevention strategy as the priority directions of medical management of high-risk pregnant women.

preeclampsia, insulin resistance syndrome, pathological insulin resistance, hyperinsulinemia, fetal nutritional and energy supply, pathogenesis concept