Relationships Between Insulin Resistance,Blood Lipids And Umbilical Artery Doppler Findings And Maternal And Fetal Outcomes In PE

Objectives:To observe the changes in insulin resistance,lipids and umbilical artery Doppler findings in PE patients and compare the maternal and fetal outcomes.Methods:The study is carried out in first affiliated hospital of Kunming medical university from May 2018 to December 2019.Total84 patients were enrolled in study group.Among them 48 patients develop early onset PE and 36 developed late onset PE.And 79 normal pregnant womens were choosen randomly as control group.Patients were studied after 20 weeks of gestation.Inclusion criteria-Age ?40 year,singleton pregnancy,nullipara,mother without any diseases and comorbidities,mother without history of chronic hypertension and diabetes,no previous history of PE and fetus without chromosomal abnormalities during the period of gestation.The variables which were used to evaluate the outcomes includes:Body Mass Index(BMI)before and after pregnancy,fasting blood sugar(FBS),fasting insulin(FINS),C.peptide,total cholesterol(TC),fasting cholesterol(FC),triglycerides(TG),high density lipoprotein(HDL),low density lipoprotein(LDL),umbilical artery doppler indices as Pulsatility index(PI),resistance index(RI),Systolic/Dystolic(SD)ratio.The maternal outcomes like cesarean section,postpartum haemorrhage and fetal outcomes like low apgar score,low pH value<7,low birth weight(Intrauterine growth retardation)and NICU admission were compared between PE and control group.The parameters were measured on two occasions before and after diagnosis of PE(late second trimester and at time of admission).The fasting blood glucose was determined by glucose oxidase method,and the five items of blood lipids were determined by mass spectrometry.Insulin Resistance(IR)is measured using HOMA-IR method.Results:The age of PE women is higher than control group with p<0.05.The pre and post pregnancy weight and BMI was higher in late onset PE women than early onset PE women and control group,p<0.05.There were no significant differences in parameters like FBG,FC,LDL,PH&BE of UA and UV with p>0.05.The FINS and C.peptide were high in early and late onset PE than control group,p<0.05.The HOMA-IR was increased in late onset PE than two groups,p<0.05 and had 2 fold higher odds of having PE(OR=2.928,CI[1.33-6.41],p=0.06).There was rise in TC,TG in second and third trimester in both PE group but more differences was seen in second trimester compared with control group and there was low HDL seen in only early onset PE in second trimester with no significant difference in all groups in first and third trimester.The TC and TG have 2.5 fold higher odds of having PE(OR=2.87,CI[1.44-5.71],p=0.002),(OR=2.778,CI[1.28-6.02],p=0.008)respectively.There were significant difference in values of parameters in three groups which was taken before diagnosis with no significant difference which were measured at time of admission.The UA PI and SD was increased in both early and late onset PE than control group when measured on two occasions but UA RI was seen raised only at time of admission with p<0.05.The UA PI,RI and SD was significantly high in severe PE women than mild PE women p<0.05 with all others parameters with no significant differences.The UA PI and SD had 2.5 and 18 fold higher odds of having PE with(OR=2.59,CI[1.11-6.07],p=0.025)and(OR=18.35,CI[2.3-142]p<0.001)respectively.There were positive relations of HOMA-IR with BMI,FBG,FINS,C.peptide with p<0.001,but negative relation with triglyceride.Maternal and perinatal outcomes:The women who had undergone CS for delivery and occurrence of PPH after delivery was high in PE women than control group with high numbers in early onset PE,p<0.05.The rate of IUGR fetus,low apgar score,and requirement of NICU admission,fetal demise was also high in early onset PE than late onset PE and control group,p<0.05.However the adverse outcomes were not related with abnormal parameters except the abnormal value of UA PI and SD were seen related with adverse maternal and fetal outcomes with significant difference,p<0.05.Overall when we compared between PE and control groups PE group had bad consequences than control group.Conclusions:1)The obesity and IR was directly related with late onset PE with increase in BMI and HOMA-IR.There was hyperlipidemia in second trimester compare to third trimester in PE groups with raise in TC and TG level compared with other lipids level.2)The abnormal value of HOMA-IR,TC,TG,UA PI and SD were seen in PE women compared to control group with higher odd ratio and significant P value.3)The severe PE women had high UA PI,RI and SD value than mild PE group.4)The adverse maternal and perinatal outcomes were associated with early onset PE and more in severe PE women.5)The UA PI and UA SD ratio had higher significance for determining the adverse maternal and perinatal outcomes compared to other variables.