Hypertensıve dısorders and dıabetıc pregnancy

Barker el al pioneered the idea that the epidemic of coronaıy heart disease in Western countries in the 2<)lh centuıy. \vhich paradoxically coincided with improved standards of living and nulrition. originaled in fetal life. an association of low birth weight with high risk of later isehemie heart disease and stroke. oı- impaired glucose tolerance and diabetes nıellilus (DM) was found in other studies. Accordingly, low birth weight was also found to be associated wilh high blood pıessure (BP) in childhood and adult life. in another sıudy, Barker el al observed that the effeds of impaired felal growth are modified by subsequent growlh. As such, individuals who were small at birth but became overweight in adulthood, were at the highest risk of heart disease and type 2 (non-insulin-dependent) DM, a physiological resislance to insulin action. This finding led to the second part of the hypothesis, the thrifty phenotype. The insulin resistance syndrome is characterized by a cluster of clinically recognizable physiological abnormalities, namely, glucose intolerance, high BP, and unfavorable lipid profile, all alterations induced by the compensatory hypeıinsulinemia. it also involves biochemical abnormalities. Insulin resistance now appears to be the epidemiological link between high BP and obesity, both risk factors for developing cardiovascular disease later in life. The insulin resistance can induce hypertension include via mechanisnıs at the cellular, circulatory, and neurological levels, as well as via possible polygenic factors. Acquired or transient insulin resisiance is associated with certain physical conditions, such as pregnaney, obesiiy, oral contraceptive use, and severe distress. Type 2, or non-insulin-dependent DM, is a state of increased insulin secretion owing to the physiological resistance of insulin action and lower than normal beta cell reserve. Diabetes in pregnaney, or geslational DM (GDM) may precede the clinical expression of type 2 DM in the nonpregnant state, even by several years. Preeclampsia and other hypertensive disorders, which are known to have a higher incidence in GDM, can be linked to increased insulin resistance. To understand the association between insulin resistance and hypertensive disorders in pregnaney, we first need to elucidate the role of insulin resistance in hypertensive disorders in the nonpregnant state. The pathogenesis of essential hypertension is multifactorial, involving complex interactions between endocrine, metabolic, and genetic factors. Obesity, aging, and diabetes can amplify genetic tendencies toward the clinical expression of the disorder. Gestational Diabetes and Hypertensive Disorders: The study of both GDM and PIH has suffered from the lack of international consensus about classification, definitions, and nomenclature, leading to difficulties in comparing studies that used different diagnostic criteria. Nevertheless, epidemiological and physiological evidence suggests that GDM and PIH are etiologically distinct entities and that GDM is strongly associated with insulin resistance and glucose intolerance, whereas preeclampsia is probably not. Pregestational diabeles and hypertensive complications İn most cases, pregestalional diabetes refers to type 1 DM; the incidence in of type 1 DM in pregnaney ranges from 0.2-0.5%. These women make up a heterogenous group in terms of duration of diabetes (White's classification), Presence of hypertension, and end-organ damage, especially damage to the eye (retinopathy) and kidney (nephropathy). Pregnancy in women with type 1 diabetes is associated with increased risks of preeclampsia, intrauterine growth restriction (IUGR), neonalal morbidily, and perinatal mortality.