the etiology of pih is not completely known , but some factors as insulin resistance , malnutrition , subclinical infections , genetic and immunological factors have been involved in the risk of developing this disorder . during normal pregnancy , some degree of insulin resistance is observed . the major degree of insulin resistance is achieved in the third trimester and returns to pre - pregnancy levels after delivery . the usual onset of pih in late pregnancy , at a time when the insulin resistance characteristic of pregnancy is maximal supports a possible association . in addition , increased risks for preeclampsia however , these studies either failed to describe proteinuria criteria or were not adjusted for body mass index ( bmi ) . it is also known that insulin resistance in late pregnancy is independently influenced by asian and south asian ethnicity . in this study , we aim to identify whether preeclampsia has the effect on insulin resistance in late pregnancy specifically in north indian women . participation in the test was voluntary and informed written consent was obtained from every participant . the study was conducted by joint collaboration of department of medicine , department of obstetrics and gynaecology and department of biochemistry of a tertiary care hospital . it was done over a period of 7 months from november 2011 to may 2012 . a total of 14 pregnant women in the third trimester with preeclampsia were recruited for this study and 14 well - matched normotensive women in the third trimester were taken as control . at enrollment , preeclampsia was defined by blood pressure recording of at least 140/90 mmhg on two occasions 6 h apart and presence of proteinuria at least 0.3 g / dl . mean arterial blood pressure ( mabp ) was calculated using the formula ( [ systolic bp + 2  diastolic bp]/3 ) . for each participant an intravenous ( iv ) cannula was sited in each arm and fasting blood samples obtained . iv load of 15 g , 50% glucose was given in an arm and 4 ml blood samples for glucose and insulin were taken at 10 , 1 , 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 10 , 12 , 14 , 16 , 20 , 22 , 23 , 24 , 25 , 27 , 30 , 40 , 50 , 60 , 70 , 80 , 90 , 100 , 120 , 160 and 180 min . we analyzed glucose and insulin concentration obtained by frequent blood sampling during the 3 h after an iv bolus of glucose . kinetic simulation was performed using minimal model analysis using python simulator for cellular systems ( pysces ) , python based open source systems simulator . from modeling of the process following parameters were derived : insulin sensitivity ( si ) , glucose effectiveness ( sg ) and pancreatic beta cell responsiveness ( first and second phase ; 1 and 2 ) . si is a measure of insulin - mediated glucose disposal and sg a measure of glucose - mediated glucose disposal . the glucose and insulin values were entered into minimal model using scipy , scientific python module . pysces was used to perform manual fitting of curves to the data by appropriate adjustment of the variable parameters . subsequently , least sum of squares iterations performed to achieve the closest possible fits and determine final parameter values . values for si , sg , 1 and 2 were then derived from these parameters . the iv glucose clearance rate ( kg ) was determined as the least square slope of the natural logarithm of glucose concentrations between 12 and 30 min after glucose bolus . acute insulin response to iv glucose ( airglucose ) was calculated as the mean of incremental plasma insulin concentrations from 0 to 10 min following iv glucose bolus . insulin - mediated , glucose - mediated and total glucose disposal during the glucose tolerance test were calculated . insulin - mediated glucose disposal was calculated as the product of the insulin sensitivity index si and airglucose ( si  airglucose ) ; this calculation has the unit min 1 in common with glucose - mediated glucose disposal sg . total glucose disposal during the tolerance test was calculated as the sum of insulin - mediated and glucose - mediated glucose disposal . the data were obtained from the glucose tolerance tests were found to be normally distributed and were analyzed by parametric statistics . the derived measurements of glucose metabolism of the women in the matched study and control groups were compared using student 's t - test . pearson 's correlation analysis was used to examine the relation between mabp and both fasting insulin and insulin sensitivity . we compared retrospectively two study groups , group 1 ( those with preeclampsia ) and group 2 ( control ) ( normotensive ) of women for factors affecting insulin sensitivity . we compared following factors : age , gestation and bmi and no significant changes were reported [ table 1 ] . significant changes in mean lipid , progesterone , cortisol or androgen concentrations between the two groups were also absent [ table 1 ] . comparison of anthropometric data and biochemical factors which might influence insulin sensitivity between the study and control groups mabp ( standard deviation [ sd ] ) at the time of the iv glucose tolerance test was 89  7.5 mmhg in the control group and 122  9.2 mmhg in the study group . mean fasting insulin levels were found to be 15.2  5.9 in normotensive control group and significantly lower 9.5  4.1 ( p = 0.02 ) in preeclamptic patients . mean fasting glucose levels were not significantly different in control and study groups ( 3.8  0.1 vs. 3.6  0.2 mmol / l , p = 0.32 ) . pearson correlation between total glucose disposal with the iv glucose clearance k , in the normotensive group of women was found to be significant ( r = 0.69 , p = 0.001 ) . in the group with preeclampsia the relative contribution of glucose - mediated glucose disposal to total glucose disposal was significantly lower ( 25.8%  2.4 vs. 50.4%  5.0 ; p = 0.003 ) compared with the women in the control group . the mabp in the normotensive women significantly correlated with both fasting insulin ( r = 0.72 , p = 0.02 ) [ figure 1 ] . correlation between mean arterial blood pressure and fasting insulin in normotensive (  ) and preeclamptic (  ) women . normotensive : r = 0.72 , p = 0.018 ; preeclamptic : r = 0.32 , p = 0.43 median plasma glucose and insulin levels during the course of the iv glucose tolerance test are shown in figures 2 and 3 ] . no significant difference between the glucose decay curves [ figure 1 ] , and between the glucose clearance rate k , in the two groups was found ( preeclamptic vs. normotensive : 2.1  0.2 vs. 2.2  0.3 ; p = 0.48 ) . therefore , there was a small but prolonged decrease in the insulin response of women with preeclampsia compared with the women in the normotensive group [ figure 3 ] . profile of median glucose concentrations during the intravenous glucose tolerance tests in the preeclamptic (  ) and normotensive (  ) pregnant women profile of median insulin concentrations during the intravenous glucose tolerance tests in preeclamptic (  ) and normotensive (  ) pregnant women table 2 compares the derived parameters from minimal model analysis in the two groups of women . mean  sd insulin sensitivity was significantly higher in women with preeclampsia than in the controls ( p = 0.018 ) . this was accompanied by a significant decrease in mean glucose effectiveness in the preeclamptic group ( p < 0.001 ) . there was no significant difference in the first or second phase insulin response or in airglucose [ table 2 ] . comparison of mean sg , si , first and second phase insulin response ( 1 and 2 ) , and ( airglucose ) between the control group and the group with ( pe ) . several studies have investigated the role of insulin resistance in development of pih . in this study , we investigated whether pih can lead to increased insulin resistance . the minimal model , developed by bergman et al . in 1979 provides an indirect measurement of metabolic insulin sensitivity / resistance on the basis of glucose and insulin data obtained during a frequently sampled iv glucose tolerance test . minimal model based insulin sensitivity has greater heritability and determined more by genetic factors , rather than measures such as homeostatic model assessment , which reflect fasting insulin . full sample protocol was preferred as it detects small changes in si in studies involving few subjects . although there are limitations with the minimal model and availability of simpler techniques like quantitative insulin sensitivity check index ( quicki ) , it is known that quicki performs best in insulin - resistant subjects , whereas si from the minimal model performs best in healthy , insulin - sensitive subjects . the main result of this study is that women who developed preeclampsia did not have increased insulin resistance compared with normotensive women in the third trimester of pregnancy . in fact the mean insulin sensitivity was found to be significantly higher in women with preeclampsia than in normotensive women . both preeclamptic and normotensive women were able to clear glucose at similar rates ( p = 0.48 for glucose clearance rate k ) we had been able to gather the pre - pregnancy bmi for each of the participants in this study . reported increased fasting insulin levels and after oral glucose tolerance testing in women with preeclampsia or gestational hypertension . however , a shortcoming in their study was that the sample population was not adjusted for bmi . . indicated similar fasting and post loading glucose levels in normotensive and preeclamptic women ; they said there is increased insulin level in preeclampsia . an inherent problem with their selection was that proteinuria criteria had not been specified for all patients . it is possible that few women who were not falling into the category of preeclampsia had been thus labeled . it should be noted from studies of madsen et al . that the insulin resistance was present in preeclamptic women was based on the demonstration of relative hyperinsulinemia , not direct measurement of insulin mediated glucose disposal . a shortcoming in our study was that we did not compare insulin sensitivity among pregnant versus non - pregnant women . although there are studies supporting increased insulin resistance during pregnancy , we might have benefitted from studying the same in this ethnic population . although it is widely accepted that insulin resistance is a causal factor in pih , we found that the converse is not true . in this study group of north indian pregnant women with preeclampsia in the third trimester
objective : the objective of this study is to investigate whether preeclampsia is associated with exacerbation of insulin resistance.materials and methods : the study was conducted over a period of 7 months from november 2011 to may 2012 , in a tertiary care hospital attached to a medical college . 
 a total of 14 pregnant women in the third trimester with preeclampsia were recruited for this study and 14 well - matched normotensive women in the third trimester were taken as control . 
 15 g , 50% dextrose load was given intravenously and blood sampling was carried out for glucose and insulin levels up to 3 h afterward . 
 minimal model analysis of glucose and insulin levels was performed to arrive at results.results:no significant changes in mean age , body mass index , gestation , serum lipid and progesterone , cortisol and androgen concentrations were recognized . 
 no significant difference was found between the glucose decay curves and between the glucose clearance rate k , in the two groups ( preeclamptic vs. normotensive : 2.1  0.2 vs. 2.2  0.3 ; p = 0.48 ) . therefore , there was a small but prolonged decrease in the insulin response of women with preeclampsia compared with women in the normotensive group.conclusion:preeclampsia per se is not a risk factor for development of insulin resistance .