Endothelium dependent hemostatic factors and subclinical inflammation in women with previous gestational diabetes mellitus (pGDM)

Women with a history of gestational diabetes (p-GDM) are at increased risk of developing type 2 diabetes mellitus later in life, and therefore at increased risk for future cardiovascular disease. The aim of this study was to investigate the endothelium dependent hemostatic factors in women with pGDM. Cross-sectional analysis was performed in pGDM women minimum 3 months after delivery who were recruited from the diabetes outpatient clinic of our hospital. 80 women with pGDM were enrolled in the study. 45 healthy women served as control subjects. We analyzed CRP, WBC, insulin, glucose, lipid profile, PAI-1, vWF, TF, tPA, and total TFPI. Subjects with a pGDM and normal subjects did not differ in mean age or number of years postpartum. As expected BMI, waist-hip ratio, percent of body fat, fat mass were higher in the women with a history of GDM. The women with a pGDM had higher fasting glucose, postprandial glucose, total cholesterol, LDL-cholesterol and triglyceride levels than women with a history of normal pregnancy; HOMA-IR and fasting insulin were also higher in the pGDM group. Compared with the control group, women with a pGDM had higher levels of CRP, WBC, fibrinogen, PAI-1 and TFPI. After adjusting for BMI, WBC, PAI?1 and TFPI remained higher in the women with pGDM. In conclusion, this study demonstrates that the increase of endothelium dependent hemostatic factors and inflammatory markers may be one of the first detectable markers in high risk of diabetes, like those with a pGDM. These findings seem to strengthen the central role of endothelial damage in the activation of vascular and coagulation abnormalities in pGDM. Keywords: Gestational Diabetes, Subclinical Inflammation, Hemostatic Factors