Preeclampsia in lean normotensive normotolerant pregnant women can be predicted by simple insulin sensitivity indexes

Certain similarities between preeclampsia and insulin resistance syndrome suggest a possible link between the 2 diseases. The aim of our study was to evaluate 3 insulin sensitivity ( IS) indexes ( fasting homeostasis model assessment IS [ISHOMA], quantitative insulin sensitivity check index [ISQUICKI], and oral glucose IS [OGIS]) early and late in pregnancy in a large number of normotensive pregnant women with a normal glucose tolerance and to test the ability of these indexes to predict the risk of subsequent preeclampsia. In all, 829 pregnant women were tested with a 75-g, 2-hour oral glucose load in 2 periods of pregnancy: early ( 16 to 20 weeks) and late ( 26 to 30 weeks). In early and late pregnancy, respectively, ISHOMA was 1.23 +/- 0.05 and 1.44 +/- 0.05 ( P < 0.01), ISQUICKI was 0.40 +/- 0.002 and 0.38 +/- 0.002 ( P < 0.01), and OGIS was 457 +/- 2.4 mL min(-1) m(-2) and 445 +/- 2.2 ( P < 0.001), all confirming the reduction in insulin sensitivity during pregnancy. Preeclampsia developed in 6.4% of the pregnant women and correlated positively with the 75th centile of ISHOMA ( P = 0.001), with a sensitivity of 79% in the early and 83% in the late period and a specificity of 97% in both. ISQUICKI < 25th centile was also related with preeclampsia ( P = 0.001), with a sensitivity of 85% in the early ;and 88% in the late period and a specificity of 97% in both. Judging from our findings, ISHOMA and ISQUICKI are simple tests that can pinpoint impaired insulin sensitivity early in the pregnancy. Given their high sensitivity and specificity, these indexes could be useful in predicting the development of preeclampsia in early pregnancy, before the disease become clinically evident.