Objective: To assess whether increased insulin resistance determined by homeostatic model assessment (HOMA) early in pregnancy is associated with the subsequent development of pregnancy-induced hypertension (PIH) in Colombian women with known risk factors. Methods: We conducted a nested case control study in a prospective cohort of 572 normotensive pregnant women, with gestational age ≤30 weeks, recruited in Bucaramanga and Floridablanca, Colombia. Fasting plasma glucose and insulin concentrations were determined at enrollment, and HOMA index was calculated. Log-transformed HOMA (log-HOMA) was used in the statistical analysis. Thirty nine PIH cases (18 preeclampsia [PE], 21 gestational hypertension [GH]) were compared to 78 controls, matched by body mass index, gestational and maternal age at enrollment. Results: Women who subsequently developed PIH had higher levels of log-HOMA at enrollment (-0.13 ± 0.54 v 0.21 ± 0.60; P = .002), which was significantly associated with the development of PIH (odds ratio 3.13, 95% confidence interval 1.41-6.94; P = .005). Higher log-HOMA was found in women who subsequently developed PE (0.28 ± 0.58; P = .003), and in those who presented with GH (0.15 ± 0.62; P = .026). Conclusions: Women who subsequently develop PIH have a higher degree of insulin resistance determined by log-HOMA early in pregnancy, before the onset of clinical manifestations of the disease. The HOMA seems to be a useful method to evaluate women at risk of developing PIH. More studies are required to confirm its usefulness as a screening tool to identify pregnant women at risk of developing PIH.