Haemostatic and cytokine changes in gestational diabetes mellitus

Abstract

Background. Limited data indicate the existence of a hypercoagulable state and the possible involvement of pro-inflammatory cytokines in the pathogenesis of gestational diabetes mellitus (GDM).

Aim. To characterise the coagulation inhibitor and cytokine profiles in women with GDM.

Methods. Two groups of women in the third trimester of pregnancy were studied: GDM (n = 150) and controls: women with normal pregnancy (n = 100); GDM in their first post-delivery day (n = 52).

Laboratory assays. Plasma fibrinogen, antithrombin (AT), protein C, total and free protein S, interleukins-2, 6 and 8 (IL-2, 6, 8).

Results. During pregnancy, the only significant alterations noted were higher levels of body mass index, fibrinogen and total protein S in women with GDM when compared to normal pregnancy. In the post-delivery group, there was further elevation in the levels of plasma fibrinogen and significant drop in the level of total protein S, protein C and AT. Significant elevation of IL-2 and IL-6 levels was recorded only in post-delivery group.

Conclusion. In GDM, the only indicator of a tendency towards hypercoagulability is the higher fibrinogen levels as compared to normal pregnancy. This feature along with the higher body mass index and presumed associated insulin resistance suggests that GDM may be a mild form of the metabolic syndrome. The lack of significant change in the levels of pro-inflammatory cytokines do not support the existence of an inflammatory state in GDM.

Keywords:

• Gestational diabetes
• coagulation inhibitors
• cytokines
• fibrinogen
• protein C
• protein S

Acknowledgements

The authors are grateful to Mr. Mohammed. A. Hamid, and Mr. Logman Gasmel Sid for their great technical assistant and their kind help and to Mrs. Farah Chatila for her secretarial work. This work is supported by a grant (LGP – 7– 35) from King Abdulaziz City for Science and Technology (KACST).