[Hemostasis and levels of cytoadhesion molecules in gestational diabetes]

Assess interrelations between parameters of haemostasis, fibrinolysis, acute stage proteins and cytoadhesive molecules in gestational diabetes (GDM), which in susceptible women is actively induced by insulin resistance.

In 33 pregnant women where based on the glucose tolerance test (75 g glucose) GDM was revealed, repeatedly fibrinogen values were assessed (FBG 4.38 +/- 0.98 g/l), the antithrombin III activity (ATIII% 103.83 +/- 14.9), t-PA Ag(4.82 +/- 3.35 ng/ml), PAI-1 Ag (158.04 +/- 57.7 ng/ml), D-dimer (234.99 +/- 455.36 ng/ml), plasma proteins-orosomucoid (ORM 0.506 +/- 0.14 g/l), C reactive protein (1.34 +/- 0.96 g/l), transferrin (3.77 +/- 0.79 g/l), prealbumin (1.86 +/- 0.83 g/l) and alpha-2-macroglobulin (A2M 2.01 +/- 0.62 g/l) and cytadhesive molecules sICAM-1 (230.8 +/- 57.76 ng/ml) and sE-selectin (35.50 +/- 16.55 ng/ml). These findings were compared with parameters of the glucose and lipid metabolism and some anthropometric data (BMI, weight increments during pregnancy and birth weight of the infant).

After statistical evaluation in GDM positive correlations of FBG and BMI were found (r = 0.871, p = 0.007) and also with the weight increment during pregnancy (r = 0.934, p = 0.0007). Hyperfibrinogenaemia is however probably compensated in stabilized cases of GDM by a higher production of t-PA (FBG:t-PA Ag, r = 0.782, p = 0.003). In GDM a marginal positive correlation between the value of the "atheroindex" and the infant's length was found r = 0.744 p = 0.0547). sE-selectin levels in GDM correlated inversely with ATIII activity (r = -0.905, p = 0.0028).

The higher body weight of pregnant women with GDM is probably associated with a higher risk of thrombophilia (elevated fibrinogen). If in pregnant women infection develops with release of inflammatory cytokines, inducing on the endothelium expression of E-selectin, deterioration of thrombophilia (due to a decline of ATIII) activity must be foreseen.