Insulin resistance syndrome predisposes to occlusive vascular disorders in nonpregnant subjects. Because preeclampsia, representing a pregnancy-specific occlusive vascular disorder, is known to be accompanied by metabolic changes similar to those in insulin resistance syndrome, we compared carbohydrate and lipid metabolism in 22 women who had a preeclamptic first pregnancy and in 22 control women who had normotensive first pregnancy, both, on the average, 17.0 +/- 0.7 yr earlier. The study groups were comparable in regard to body mass index at the follow-up study. Women with prior preeclampsia were normoglycemic (baseline, 3 h oral glucose tolerance), but showed a significant hyperinsulinemia, as seen from elevated immunoreactive insulin (IRI) levels at the baseline (mean +/- SE, 7.3 +/- 0.6 vs. 5.5 +/- 0.5 mU/L; P < 0.03), after 1 h (45.7 +/- 5.5 vs. 35.6 +/- 3.5 mU/L; P = 0.13), after 2 h (32.4 +/- 4.1 vs. 23.8 +/- 2.3 mU/L; P = 0.08), and after 3 h (10.1 +/- 1.4 vs. 6.4 +/- 0.6 mU/L; P = 0.02). The area under the IRI curve was larger in the women with prior preeclampsia (86.8 +/- 9.1 vs. 65.4 +/- 5.2 mU/h.L; P = 0.05). The serum levels of total cholesterol, high density lipoprotein (HDL) cholesterol (with its subfractions HDL2 and HDL3), low density lipoprotein cholesterol, triglyceride, or uric acid did not differ significantly between the study groups. In women with prior preeclamsia, the area under the IRI curve was negatively related to HDL2 cholesterol, but positively related to triglyceride and systolic blood pressure. We conclude that a history of preeclampsia is associated with mild hyperinsulinemia in nonpregnant women.