Bishop score and transvaginal ultrasound for preinduction cervical assessment: a randomized clinical trial.

OBJECTIVE: To compare transvaginal ultrasound with the Bishop score in assessment of cervical ripening for choice of induction agent. METHODS: Eighty women were randomized to have preinduction cervical assessment for choice of induction agent based on either Bishop score or transvaginal ultrasound. The primary outcome measure was the percentage of women who were administered prostaglandin as a preinduction agent. The criteria for considering the cervix as unripe and thus for using prostaglandin were either a Bishop score < 6 or a cervical length > 30 mm with cervical wedging of < 30% of the total cervical length. Secondary outcome measures included interval to active phase, interval to delivery and rate of Cesarean section. RESULTS: While 85% of women received prostaglandin in the Bishop score group, only 50% of them did in the transvaginal ultrasound group (P = 0.001). The interval to active phase, interval to delivery and rate of Cesarean section were similar in both groups. CONCLUSIONS: With the suggested cut-off values of a Bishop score < 6 or a cervical length > 30 mm and wedging < 30%, the use of transvaginal ultrasound instead of Bishop score for preinduction cervical assessment to choose induction agent significantly reduces the need for intracervical prostaglandin treatment without adversely affecting the success of induction.

Diagnóstico temprano del cáncer de ovario / No disponible

No disponible

Maternal anxiety and fetal behavior at 15 weeks' gestation.

OBJECTIVE: To analyze the relationship between maternal anxiety and fetal behavior at 15 weeks' gestation. METHODS: Twenty women in two groups were studied: 10 women underwent amniocentesis and 10 controls did not. Maternal anxiety was evaluated using the State Trait Anxiety Inventory questionnaire. Maternal plasma catecholamines (noradrenaline, adrenaline, dopamine) and maternal serum adrenocorticotropic hormone, cortisol, glucose, insulin, triiodothyronine, thyroxine and thyroid-stimulating hormone were measured. Catecholamines were also measured in the amniotic fluid of women undergoing amniocentesis. Compiled actograms of 40-min observations were done using ultrasonography. RESULTS: Maternal state-anxiety was significantly increased in the amniocentesis group. Except for fetal hiccups (r = 0.49, P = 0.03) there was no significant correlation between maternal anxiety and any of the other studied fetal movements. Maternal glucose was significantly correlated with hiccups (r = -0.59, P = 0.01), isolated leg movements (r = -0.52, P = 0.03), startles (r = -0.47, P = 0.04) and the total of the studied movements (r = -0.47, P = 0.04). Amniotic fluid catecholamines were significantly correlated with hand-face contact (r = 0.71, P = 0.02 for adrenaline), startles (r = 0.75, P = 0.01 for noradrenaline and r = 0.64, P = 0.04 for dopamine) and general movements (r = 0.89, P = 0.001 for noradrenaline). CONCLUSIONS: This study does not support a relationship between maternal anxiety and fetal behavior in early pregnancy. Maternal glucose and plasma catecholamines could be related to fetal movements at 15 weeks' gestation.

Alcohol y cáncer de mama / Alcohol and breast cancer

No disponible

Inducción del parto en gestantes con prueba de oxitocina de resultado dudoso / Labor induction in pregnant women with a pre-pathologic oxigen challenge test result

Objetivo: Comparar los resultados obstétricos y perinatales de la inducción del parto en gestantes con prueba de oxitocina (POC) de resultado dudoso con aquellos de resultado negativo.Material y métodos: Se comparan 143 mujeres con POC de resultado dudoso con 306 de resultado negativo. Las principales variables estudiadas fueron la tasa de cesáreas por sufrimiento fetal, los ingresos en la unidad de neonatología y el test de Apgar a los 5 min de vida. Resultados: La tasa de cesáreas por sufrimiento fetal fue significativamente superior en el grupo de mujeres con prueba de resultado dudoso (el 13,3 frente al 1,9 por ciento) (p < 0,001). No existieron diferencias estadísticamente significativas en el porcentaje de ingresos en la unidad de neonatología, ni en el test de Apgar. Conclusiones: La inducción del parto parece segura en mujeres con POC dudosa, si bien lógicamente la tasa de cesáreas por sufrimiento fetal está incrementada. (AU)

Fetal chylothorax response to maternal dietary treatment.

BACKGROUND: Fetal chylothorax is associated with elevated perinatal mortality. Development of mediastinal shift with significant lung compression before 35 weeks' gestation needs treatment. CASE: A 24-year-old gravida 2, para 0 presented at 26 weeks' gestation with a fetal pleural effusion with a mediastinal shift and abnormal Doppler velocimetry indices in several vessels. Thoracentesis was successful but 3 days later, the fetal effusion had reaccumulated. Because of fetal position, a pleuro-amniotic shunt was difficult technically, so maternal medical treatment was initiated with a low-fat, high medium-chain triglyceride diet. After initial mild decrease, the estimated volume of the fetal chylothorax remained stable until 36 weeks' gestation, at which time we delivered by cesarean an infant with good Apgar scores. After aspiration of the remaining thoracic fluid and administration of a similar diet, the infant did well, with normal growth and development. CONCLUSION: Maternal dietary treatment might help delay the need for thoracentesis in cases of fetal chylothorax.

Postpartum metabolism and autoantibody markers in women with gestational diabetes mellitus diagnosed in early pregnancy.

OBJECTIVE: Our purpose was to study postpartum metabolism and autoantibody markers of type 1 diabetes mellitus in women with gestational diabetes mellitus diagnosed in early pregnancy. STUDY DESIGN: Thirty women with gestational diabetes diagnosed in early pregnancy were compared with 72 women who had gestational diabetes diagnosed in late pregnancy. Glucose tolerance, parameters of carbohydrate and lipid metabolism, and antibodies to glutamic acid decarboxylase and to islet cells were measured. RESULTS: The percentages of overt diabetes and abnormal glucose tolerance were significantly higher in the early-pregnancy group (26.7% vs 1.4%; P =.0002; and 40% vs 5.56%; P <.0001; respectively). Only 1 woman had positive test results for antibodies to the islet cells. The rate of positive test results for antibodies to glutamic acid decarboxylase was similar in both groups (13.7% vs 9.3%). CONCLUSIONS: Women with early gestational diabetes have an increased risk of postpartum diabetes mellitus, whereas those with late-onset gestational diabetes have a minimal risk. In women predisposed to type 1 diabetes, gestational diabetes develops either early or late in pregnancy.

The relationships between leptin and inflammatory cytokines in women with pre-eclampsia.

OBJECTIVE: To compare maternal serum leptin concentration in women with pre-eclampsia and women with normal pregnancy, and to evaluate the relationships between leptin and several inflammatory cytokines. DESIGN: Prospective clinical study. SETTING: University Hospital of Puerto Real, Cadiz, Spain. SAMPLE: Twenty-seven women with pre-eclampsia and 25 normotensive pregnant women. METHODS: Maternal serum levels of TNF-alpha, TGF-beta1, interleukin 6, and leptin were measured using a commercially available immunoassay. MAIN OUTCOME MEASURES: Maternal serum levels of leptin and its relationship to levels of TNF-alpha, TGF-beta1 and interleukin 6. RESULTS: Maternal serum leptin levels were higher in women with pre-eclampsia, but this difference was of borderline statistical significance (median 15.9 ng/mL; interquartile range (5.4-31.9) vs 30.5 ng/mL (13.9-64) (P = 0.05). The concentration of maternal serum leptin was correlated with pre-gestational and gestational body mass index (r = 0.45, P = 0.03; r = 0.44, P = 0.04), TNF-alpha concentration (r = 0.57, P = 0.002) and interleukin-6 level (r = 0.46, P = 0.02) in women with normal pregnancy. In women with pre-eclampsia, only a significant correlation between maternal serum leptin level and TNF-alpha concentration (0.47, P = 0.01) was found. CONCLUSIONS: The level of maternal serum leptin is increased and correlates positively with the level of TNF-alpha in women with pre-eclampsia. In women with a normal pregnancy leptin levels not only correlate with TNF-alpha, but also with IL-6 and body mass index.

Alpha-fetoprotein and hematopoietic growth factors in amniotic fluid.

OBJECTIVE: To determine whether a relationship exists between alpha-fetoprotein (AFP) and hematopoietic growth factors in amniotic fluid. METHODS: Forty-one women at 15 weeks' gestation were included in the study. Gestational age was assessed by obtaining a reliable menstrual history and scanning. Amniocentesis was performed, and each woman subsequently delivered anatomically and chromosomally normal infants. The level of AFP was determined using a standard automated procedure. The concentrations of stem cell factor, interleukin 3, interleukin 6, erythropoietin, and granulocyte colony-stimulating factor (G-CSF) were measured using a commercially available immunoassay. The relationships between AFP and the studied cytokines were evaluated using the Pearson linear correlation test. Significant correlations were studied further by linear and nonlinear regression to obtain the best predictive model. RESULTS: There was a significant correlation between AFP and stem cell factor (r =.47, P =.002). No significant correlations between AFP and the rest of the studied cytokines were found (r = -.07, r =.02, r = -.02, and r = -.11 for erythropoietin, G-CSF, interleukin 3, and interleukin 6, respectively). CONCLUSION: Alpha-fetoprotein is significantly correlated with stem cell factor in early pregnancy and might play a role in fetal hematopoiesis.

Lymphocyte subpopulations after normal pregnancy and spontaneous abortion in primigravidas.

OBJECTIVE: To evaluate lymphocyte subpopulations after a first pregnancy in women who had normal pregnancies and in those whose pregnancies terminated in spontaneous abortion. STUDY DESIGN: Sixty healthy, nonpregnant women in three groups were studied: 20 with a prior abortion, 20 with a prior normal pregnancy and 20 nulligravid. Peripheral blood lymphocytes were studied using monoclonal antibodies and flow cytometry. Women were followed for one year, and if they became pregnant again, pregnancy complications were recorded. RESULTS: The percentage of B lymphocytes was significantly decreased in the postpartum group (6% +/- 2.22) in comparison to nulligravid women (8.7% +/- 3.37) (P = .005). The percentage of CD4 lymphocytes was significantly higher in the postabortion group (44.7% +/- 7.81) in relation to the control group (39.85% +/- 6.01) (P = .03). A significantly higher CD4/CD8 ratio was found in the postabortion group in relation to the control group (1.65 vs. 1.24) (P = .01). Women with pregnancy complications in their next pregnancy had a lower absolute value for total lymphocytes (P = .02), T lymphocytes (P = .04), absolute CD8 lymphocytes (P = .01) and percentage of CD8 lymphocytes (P = .02) and a higher percentage of CD4 lymphocytes (P = .03) and higher CD4/CD8 ratio (P = .02) than women who had not experienced any pregnancy complications. CONCLUSION: The percentage of B lymphocytes was lower in normal primipara in comparison to women who had never been pregnant. Women with previous spontaneous abortions had an immunologic profile expected in a rejection phenomenon; that result was more marked if they went on to experience complications in their next pregnancies.

Oral misoprostol and intracervical dinoprostone for cervical ripening and labor induction: a randomized comparison.

OBJECTIVE: To compare efficacy, safety, and tolerance of oral misoprostol with intracervical dinoprostone for cervical ripening and labor induction. METHODS: Two hundred women were randomized to receive single doses of oral misoprostol 200 microg or 0.5 mg of dinoprostone intracervically every 6 hours for a maximum four doses. RESULTS: The intervals from administration of the drug to active phase of labor (11.1 hours [7-24] versus 15.8 hours [7.5-29.62], P =. 01), to delivery (14.0 hours [8.42-27.61] versus 20.2 hours [16.7-32. 8], P =.01), and to rupture of membranes (10.0 hours [4.95-24.7] versus 15.6 hours [8.2-29.2], P =.003) were significantly shorter in the misoprostol group. All those variables were not distributed normally, so results are presented as median and interquartile range. The rates of women who needed oxytocin (68% versus 52%, P =.03) and cesarean for failed induction (9% versus 1%, P =.01) were higher in the dinoprostone group. CONCLUSION: A single dose of 200 microg oral misoprostol was more effective for cervical ripening and labor induction than 0.5 mg of dinoprostone intracervically every 6 hours, with a maximum of four doses.

Insulin-sensitivity index and carbohydrate and lipid metabolism in gestational diabetes.

OBJECTIVE: To study insulin action in normal and gestational diabetic pregnant women by using an insulin tolerance test. STUDY DESIGN: Twenty-four women diagnosed as having gestational diabetes were compared to 22 nondiabetic, matched controls. The insulin-tolerance test (ITT) consisted of an intravenous bolus of 0.1 IU/kg of regular insulin with glucose sampling at -5, 0, 3, 5, 7, 10 and 15 minutes. The insulin sensitivity index (ISI) was assessed by using a delta G/G0 ratio (G0 = initial glycemia level, delta G = variation between G0 and glycemia level obtained at 15 minutes by calculation of the regression plot). RESULTS: Two women had glucose levels < 50 mg/dL at 15 minutes, without clinical symptoms. Women with gestational diabetes had a significantly lower level than those with normal glucose tolerance. The rate of abnormal insulin resistance (ISI) (< 10th percentile in the control group) was significantly higher in the insulin-treated subgroup (8/11, 72.7%, vs. 2/12, 16.6%). ISI correlated negatively with glycemia (r = -.38, P = .01) and glycosylated hemoglobin (r = -.50, P = .001) and correlated positively with low density lipoprotein-c (r = -.40, P = .01) and apolipoprotein B (r = -.42, P = .01). In the gestational diabetes group, ISI was correlated negatively with gestational age (r = -.50, P = .01) and triglycerides (r = -.50, P = .01). CONCLUSION: ITT seems to be a safe and rapid method of measuring in vivo insulin action in pregnant women. Women with gestational diabetes had higher insulin resistance, especially those who needed insulin therapy. Lipid profile in gestational diabetes was related to the level of insulin resistance.

Gestational diabetes mellitus diagnosed during early pregnancy.

OBJECTIVE: This study was undertaken to compare pregnancy complications, obstetric outcomes, and perinatal outcomes between women with early-onset and late-onset gestational diabetes mellitus. STUDY DESIGN: Fifty-gram oral glucose challenge screening was conducted among 3986 pregnant women at the time of their first antenatal visit. Women without abnormal results underwent another test at 24 to 28 weeks' gestation. Patients with gestational diabetes mellitus in early pregnancy were compared with those who had a normal glucose tolerance at the time of this first test but in whom diabetes subsequently developed. RESULTS: Women with early-onset gestational diabetes mellitus (n = 65) were likely to be hypertensive (18.46% vs 5.88%; P =.006) and had higher glycemic values and need for insulin therapy (33.85% vs 7.06%, P =.0000) than those in whom diabetes developed later (n = 170). All the cases of neonatal hypoglycemia (n = 4) and all perinatal deaths (n = 3) were within this group (P =.005 and P =.01, respectively). CONCLUSIONS: Women with an early diagnosis of gestational diabetes represent a high-risk subgroup.

Sex hormone-binding globulin in gestational diabetes.

BACKGROUND: Insulin is an important regulator of serum sex hormone-binding globulin (SHBG) concentration which works by inhibiting its production in hepatocytes. Low SHBG level is associated with increased insulin resistance and hyperinsulinemia. Our purpose was to compare maternal serum SHBG level between normal and gestational diabetic pregnant women and to study the relationships between SHBG, SHBG/insulin and SHBG/glucose ratio and several endocrine, metabolic and clinical parameters. METHODS: Serum SHBG concentrations were measured in 34 women with gestational diabetes and in 32 matched controls. Glucose, insulin, C-peptide, fructosamine, beta-HCG, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, total and free T4, total and free estriol, T3 and IGF-1 were measured. Insulin sensitivity was estimated using the short insulin tolerance test. RESULTS: SHBG, SHBG/insulinemia ratio and SHBG/glucose ratio were significantly lower in the diabetic group (309.54 +/- 112.22 vs 460.54 +/- 144.54, p = 0.00001), (33.55 +/- 16.62 vs 72.56 +/- 66.50, p = 0.0006 using log-transformed values), (5.88 +/- 1.87 vs 3.39 +/- 1.23, p < 0.00001). SHBG was negatively correlated with insulinemia (r = -0.40, p = 0.001), C-peptide (r = -0.41, p = 0.001), glycemia (r = -0.27, p = 0.02), diastolic blood pressure (r = -0.41, p = 0.001) and beta-HCG (r = -0.41, p = 0.001) and positively correlated with LDL-c (r = 0.25, p = 0.04) and apolipoprotein B (r = 0.33, p = 0.007). CONCLUSIONS: SHBG concentrations are lower in gestational diabetic pregnant women and are related to insulin levels but not to peripheral insulin sensitivity. Since insulinemia was similar in normal and gestational diabetic pregnant women, we speculate that gestational diabetes is characterized by a higher peripheral insulin resistance, a fasting normal insulinemia and a higher hepatic insulin sensitivity, at least in other actions than on carbohydrate metabolism. The role of sex steroids, T4 and IGF-1 in regulating SHBG appears to be limited during pregnancy.

Relationship between alpha-fetoprotein and fetal erythropoiesis.

OBJECTIVE: To evaluate the relationship of fetal erythropoiesis to both maternal and fetal serum alpha-fetoprotein (AFP) levels. STUDY DESIGN: We evaluated the relationships between maternal serum AFP levels and fetal hemoglobin, hematocrit, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration in 63 fetuses, 19 of them by prenatal cordocentesis and 44 at elective cesarean section before labor. We also evaluated the relationships between fetal AFP and fetal hemoglobin, hematocrit, red blood cell count, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, erythroblasts, erythropoietin, serum iron, transferrin, ferritin, bilirubin, total proteins and albumin in 51 umbilical cords immediately after singleton childbirth, in healthy, pregnant women at term. Statistical analysis was performed by linear regression. RESULTS: After adjustment according to gestational age, significant correlations were found between maternal AFP and fetal hemoglobin (r = -.30, P = .017) and hematocrit (r = -.25, P = .044). We also found a significant negative correlation between fetal serum alpha-fetoprotein and fetal red blood cells (r = -.55, P = .000026), hemoglobin (r = -.40, P = .0035), hematocrit (r = -.46, P = .00052), erythropoietin (r = -.40, P = .005) and transferrin (r = -.33, P = .016). Erythropoietin also positively correlated with fetal red blood cells (r = .47, P = .001), hemoglobin (r = .45, P = .001), hematocrit (r = .47, P = .001) and erythroblasts (r = .42, P = .003). CONCLUSION: Since a significant negative correlation was demonstrated between fetal red blood cell count, hemoglobin, hematocrit, erythropoietin and AFP, it is reasonable to speculate that AFP could play a role in fetal erythropoiesis.

Lymphocyte subpopulations in intrauterine growth retardation in women with or without previous pregnancies.

OBJECTIVE: To evaluate lymphocyte subpopulations in pregnant women with intrauterine growth retardation (IUGR). STUDY DESIGN: Forty-two normotensive and healthy women with singleton pregnancies and intrauterine growth retardation were studied in the third trimester of pregnancy and compared with 42 normal pregnant women. Peripheral blood lymphocytes were studied using murine monoclonal antibodies and flow cytometry. RESULTS: B-lymphocytes in both total number (312.54 vs. 163.19 cells/mm3; P = 0.000003) and percentage (11.04% vs. 7.07%; P = 0.000002) were significantly increased in patients with IUGR in comparison to normal pregnant women. Significant correlations were found between birthweight and both total number and percentage of lymphocytes B. In primigravid women, we found that women with IUGR had a higher total lymphocyte count (2749.09 vs. 2130 cells/mm3; P = 0.006), higher T-lymphocyte count (2053.77 vs. 1676.40 cells/mm3; P = 0.02), higher B-lymphocyte count and percentage (309.13 vs. 145.36 cells/mm3; P = 0.000001) (11.45 vs. 6.81%); P = 0.00001), higher CD4 lymphocyte count and percentage (1342.68 vs. 972.22 cells/mm3, P = 0.001) (49.18 vs. 44.04%; P = 0.04), lower CD8-lymphocytes percentage (28.27 vs. 32.9%; P = 0.04), and higher CD4/CD ratio (1.83 vs. 1.46; P = 0.02) than the normal control group. CONCLUSIONS: B-lymphocytes are increased in women with IUGR in comparison to women with normal pregnancies and there was a significant negative correlation between maternal B-lymphocytes and birthweight. With respect to T-lymphocytes, the immunological profile is different according to the presence or absence of a previous pregnancy. Fetal immunological rejection could be involved in the pathogenesis of IUGR in primigravid women, but in multigravid women there were no differences between women with IUGR and those with normal fetal growth.

Maternal serum nitric oxide levels associated with biochemical and clinical parameters in hypertension in pregnancy.

OBJECTIVES: To measure maternal serum concentrations of total nitrites, as an index of nitric oxide synthesis, in normal and hypertensive pregnant women, and to examine the correlation between these concentrations and several variables of clinical interest. STUDY DESIGN: A total of 60 women in four different groups were studied: 10 normotensive pregnant women, 17 pregnant women with preeclampsia, 18 pregnant women with gestational hypertension and 15 pregnant women with chronic hypertension. Serum nitrite levels were determined using the Griess reaction after reduction with nitrate reductase. RESULTS: Serum nitrite levels were higher in preeclamptic women (34.11+/-14 micromol/l, P=0.04), lower in chronic hypertensive women (19.56+/-6.46 micromol/l, P=0.04) and similar in women with gestational hypertension (26.97+/-9.44 micromol/l) in comparison to the control group (25.37+/-7.24 micromol/l). Serum nitrite levels in preeclamptic women had significant positive correlations with hematocrit, fasting insulinemia, and apolipoprotein B and negative correlations with platelet count, serum phosphorus and glucose:insulin ratio. In pregnant women with chronic hypertension a negative correlation was found between serum nitrite levels and active partial thromboplastin time. In pregnant women with gestational hypertension, serum nitrite levels had negative correlations with birthweight and 24-h urine calcium, and positive correlations with mean corspuscular hemoglobin, 24-h urine sodium and maternal age. CONCLUSIONS: We suggest that in women with preeclampsia, a higher maternal nitric oxide level may act as a compensatory mechanism against hemoconcentration and platelet aggregation and that nitric oxide production may be related to some metabolic events. In women with gestational hypertension, higher serum nitrite levels may be related to clinical and biochemical findings common in preeclampsia. In chronic hypertension, a lower maternal nitric oxide level is related to the status of coagulation.

Umbilical blood flow and neonatal morphometry: a multivariate analysis.

OBJECTIVE: To study the relation between the state of umbilical blood flow and neonatal morphometry. STUDY DESIGN: We have recorded data from 460 pregnant women. Umbilical systolic to diastolic ratio was measured within the 3 days prior to the birth. Weight, height, head and chest circumferences, ponderal and head to chest circumferences ratio were considered for the study. RESULTS: In a univariate analysis, the best correlated variable to S/D ratio was the weight (r=-0.35). However, a forward stepwise multiple regression analysis demonstrated that the best predictors of S/D ratio were height and ponderal index. Small-for-gestational-age fetuses with placental insufficiency (n=20) had a significant more pronounced decrease of weight, height, head circumference and chest circumference than those with normal placental perfusion (n=31). The degree of decrease of ponderal index and HC/TC was similar in both groups. CONCLUSIONS: Umbilical blood flow is one important factor determining newborn morphometry. If only one growth variable is considered, the best correlation with umbilical S/D ratio is found to be the weight. The multivariate regression analysis concluded that the two most influential factors by umbilical blood flow are height and ponderal index and the rest of the morphometric parameters lost their significant correlations when adjusted by these variables. The impairment on neonatal morphometry in small-for-gestational-age fetuses associated to placental insufficiency is more severe than that with normal placental perfusion. However, it does not have a more pronounced decrease of ponderal index than the rest of causes of small-for-gestational-age fetuses.

Carbohydrate metabolism. Evaluation in women with de novo hypertension in late pregnancy.

OBJECTIVE: To evaluate carbohydrate metabolism in both diabetic and nondiabetic women with de novo hypertension in late pregnancy. STUDY DESIGN: Sixty-nine nondiabetic pregnant women were studied: 33 with gestational hypertension, 15 with preeclampsia and 21 normotensives in the control group. Eight women with gestational diabetes and hypertension were evaluated separately. Glucose and insulin serum levels were evaluated in the fasting state and during an oral glucose load. Glucose-independent parameters were used to evaluate insulin response, insulin activity and glucose tolerance in fasting and postglucose ingestion states. Student's t test was used. RESULTS: Fasting glycemia was lower in both groups with de novo hypertension in late pregnancy than in the control group. Glycemia was higher throughout the oral glucose load in gestational hypertension than in preeclampsia. Insulinemia during the oral glucose load was higher in gestational hypertension than in both the control and preeclampsia groups. Fasting corrected insulin response and glucose tolerance were higher in gestational hypertension and preeclampsia than in the control group. In the postglucose ingestion state, insulin activity and glucose tolerance was lower in gestational hypertension than in preeclampsia. Women with gestational diabetes and hypertension were very insulin resistant. CONCLUSION: Glucose tolerance was not only decreased but also increased in the fasting state in de novo hypertension in late pregnancy due to a high insulin response. In the postglucose ingestion state, the gestational hypertension trend was toward insulin resistance even though normal insulin activity occurs in preeclampsia. Gestational diabetes associated with gestational hypertension was characterized by high insulin resistance.