Gestational diabetes mellitus is associated with antenatal hypercoagulability and hyperfibrinolysis: a case control study of Chinese women

Abstract

Background

To determine the relationship between gestational diabetes mellitus (GDM) and coagulation/fibrinolysis abnormality in antenatal Chinese women.

Methods

Case control study: 50 women had GDM and 132 did not (the NGDM group) grouping by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Maternal plasma biochemistry and previous medical history were collected from perinatal health records. Antenatal coagulation/fibrinolysis activity (CFA) parameters were assessed using thromboelastography and routine CFA parameters, respectively. Univariate and multiple regression analyses were used to evaluate the associations between GDM and CFA parameters. Maternal age, platelet, ALT, ALP, urea nitrogen, and previous history of abortion were taken as the covariables.

Results

The women with GDM were significantly older than those without GDM (30.3 vs. 28.6 years, p = .012). Compared with the NGDM group, the GDM group had a significantly higher prevalence of cesarean delivery (56.0 vs. 37.9%, p = .027) and higher values of fibrinogen (FIB; 4.7 vs. 4.3 g/L, p = .001), activated partial thromboplastin time (APTT; 30.9 vs. 29.5 s, p = .010).There were no significant differences in the prevalence of maternal thrombotic events or neonatal events. GDM was significantly associated with higher APTT (β =1.41 s, 95% CI: 0.29–2.53), higher FIB (β = 0.38 g/L, 95% CI: 0.14–0.61), and higher percentage reduction in clot lysis after 30 min (LY30; β = 1.14%, 95% CI: 0.15–2.13) after adjustment for potential confounding factors.

Conclusions

GDM is significantly associated with hypercoagulability and hyperfibrinolysis in these antenatal Chinese women.

Keywords:

• Gestational diabetes mellitus
• hypercoagulability
• hyperfibrinolysis
• thromboelastography

Acknowledgments

The authors thank all the staff members in our institution, and especially Mr. Liu Shunshun, Mr. Sun Guoping, and Miss. Sun Lemeng. All the analyses were performed using EmpowerStats (http://www.empowerstats.com, X&Y Solutions, Inc, Boston, MA). And the Empower team, especially Miss Chen Xinglin, PhD, gave us a lot of help in data analysis. We also thank Mrs. Tang Shao Hua, a language professor from Yangzhou University and Mark Cleasby, PhD, from Liwen Bianji, Edanz Group China for editing the English text of a draft of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

YL, XFS, JXT, CL, and JC were responsible for conception, design of the study, acquisition, analysis, and interpretation of data. WW and XS were responsible for the test and quality control of CFA assessment. DL and DMZ were responsible for the discrimination of obstetric diseases. YL, BS, and YL drafted the article and revised contents. All authors have read and approved the final version of the manuscript.

Additional information

Funding

Writing of the manuscript was supported in part by the TCM Leading Talents Training Project of Jiangsu Province (SLJ0209).