Preeclampsia features in pregnancy with gestational diabetes mellitus

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Abstract

Hypothesis/aims of study. The high prevalence of gestational diabetes mellitus (GDM) and the social importance of preeclampsia (PE) due to massive perinatal morbidity and mortality, as well as the high rate of PE in GDM pregnancy define the need to study the characteristics of pregnancy course in these women to develop the prevention and management of pregnancy complication. This study aimed at evaluating clinical and laboratory features of PE in GDM pregnancy.

Study design, materials and methods. According to the inclusion criteria, 112 pregnant women were enrolled in this prospective cohort study after 24 weeks of gestation: with GDM and PE (n = 24), with PE (n = 22); with GDM (n = 37), without studied pregnancy complications (n = 37). We assessed serum levels of placental growth factor (PIGF) and soluble FMS-like tyrosine kinase-1 (sFlt-1). Pregnancy course and labour were evaluated using medical history.

Results. Severe PE developed more often (p = 0.0014, Chi-square test) in the PE group (59%, n = 13) compared to the GDM + PE group (13%, n = 3). Elective preterm labour occurred more often in the PE group compared to other study groups (PE: 23%, n = 5; GDM + PE: 9%, n = 2; p < 0.0001, Chi-square test with Yates correction), which is in line with the severity of PE in this group. The rate of preterm labour did not differ between the GDM + PE group and the group without studied pregnancy complications. Moreover, the mean fasting glucose level was higher in the GDM group compared to the GDM + PE group (p = 0.01, Mann–Whitney test). The GDM + PE group was characterized by fasting hyperglycemia episodes and a basal insulin regimen, while the GDM group by postprandial glucose peaks, and a bolus insulin regimen. Women with GDM + PE were notable for the high pre-pregnancy body mass index (29.0 ± 6.58 kg/m2), and a family history of DM was more typical for women with GDM without PE (59%, n = 19). The sFlt-1/PIGF ratio did not differ between the GDM + PE, GDM and control groups and was lower compared to the PE group (p < 0.0001, Fisher’s LSD test). PIGF level was not different in the GDM + PE and GDM groups, but was lower compared to the control group.

Conclusion. Our study showed that PE in women with GDM is more benign than in patients without GDM, taking into account both clinical and laboratory signs. At the same time, obesity appears to be one of the most important risk factors for the both pregnancy complications. The data of this study, in addition to those described in the literature, suggest that initial carbohydrate disorders play a disease-limiting, protective role in a vicious cycle of PE due to angiogenesis stimulation. The use of angiogenesis factors as markers of PE in GDM patients is limited, which requires further research.

About the authors

Ofelia A. Bettikher

V.A. A lmazov National Medical Research Center

Author for correspondence.
Email: ophelia.bettikher@gmail.com
ORCID iD: 0000-0002-1161-1558
SPIN-code: 4398-3964

MD, Post-Graduate Student. The Department of Obstetrics and Gynecology, the Faculty of Medicine, the Institute of Medical Education

Russian Federation, Saint Petersburg

Irina E. Zazerskaya

V.A. A lmazov National Medical Research Center

Email: zazera@mail.ru
ORCID iD: 0000-0002-8175-7886
SPIN-code: 5873-2280

MD, PhD, DSci (Medicine), the Head of the Department of Obstetrics and Gynecology. The Faculty of Medicine, the Institute of Medical Education

Russian Federation, Saint Petersburg

Polina V. Popova

V.A. A lmazov National Medical Research Center

Email: pvpopova@yandex.ru
ORCID iD: 0000-0002-3697-7791
SPIN-code: 1150-3432

MD, PhD, the Head of the Research Laboratory for Endocrine Diseases in Pregnant Women. The Institute of Endocrinology

Russian Federation, Saint Petersburg

Elena Yu. Vasilyeva

V.A. A lmazov National Medical Research Center

Email: elena-almazlab@yandex.ru
ORCID iD: 0000-0002-2115-8873
SPIN-code: 8546-5546

MD, the Head of the Central Clinical Diagnostic Laboratory

Russian Federation, Saint Petersburg

Viktor A. Bart

V.A. A lmazov National Medical Research Center

Email: vbartvit@mail.ru
ORCID iD: 0000-0002-9406-4421
SPIN-code: 9400-0754

PhD, the Head of the Research Laboratory of Biostatistics. The Research Department of Mathematical Modeling and Analysis

Russian Federation, Saint Petersburg

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2. Fig. 1. Placental growth factor levels in the survey groups: 1 — gestational diabetes mellitus + preeclampsia; 2 — preeclampsia; 3 — gestational diabetes mellitus; 4 — controls; CI — confidential interval; F — criterion ANOVA; p — statistical significance level

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3. Fig. 2. Soluble FMS-like tyrosine kinase-1 levels in the survey groups: 1 — gestational diabetes mellitus + preeclampsia; 2 — preeclampsia; 3 — gestational diabetes mellitus; 4 — controls; CI — confidential interval; F — criterion ANOVA; p — statistical significance level

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4. Fig. 3. Soluble FMS-like tyrosine kinase-1 / placental growth factor ratios in the survey groups: 1 — gestational diabetes mellitus + preeclampsia; 2 — preeclampsia; 3 — gestational diabetes mellitus; 4 — controls; CI — confidential interval; F — criterion ANOVA; p — statistical significance level

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Copyright (c) 2019 Bettikher O.A., Zazerskaya I.E., Popova P.V., Vasilyeva E.Y., Bart V.A.

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