Is There a Tendency for Thrombosis in Gestational Diabetes Mellitus?

Abstract

Context:Impact of gestational diabetes mellitus (GDM) on the coagulation system, dynamics involved at a pathophysiological level and the exact mechanism remain unclear.Aims:To evaluate the association between diabetes-related parameters and hemostatic factors to search for a tendency of thrombosis in GDM.Settings and Design:Nineteen pregnant women who had GDM, 16 healthy pregnant and 13 healthy nonpregnant controls admitted to the Endocrinology outpatient clinics were enrolled in the study.Subjects and Methods:Fasting and postprandial glucose, hemoglobin A1c and insulin levels, and insulin resistance; fructosamine, thrombin activatable fibrinolysis inhibitor (TAFI), tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor Type-1 (PAI-1), tissue-type plasminogen activator (t-PA), fibrinogen, plasminogen and hemoglobin levels, platelet counts, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were studied.Statistical Analysis Used:One-way analysis of variance, Kruskal–Wallis, and post hoc Tukey honestly significant difference or Conover's nonparametric multiple comparison tests for comparison of the study groups.Results:PT and aPTT were significantly lower in GDM patients compared to controls (P < 0.05), whereas fibrinogen and plasminogen levels were significantly higher in this group compared to both nonpregnant and healthy pregnant controls (P < 0.05 for each). TAFI, TFPI, PAI-1, and tissue t-PA levels were not significantly different among groups.Conclusions:Our findings indicate tendency to develop thrombosis in GDM similar to diabetes mellitus; but more comprehensive studies with larger sample size are needed to determine the relationship between GDM and hemostasis.

Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies

“…They also found that GDM is associated with higher TAT complex, and lower protein C and S compared to normal pregnancy. Gorar et al [20] in 2016 reported higher PAI-1 and lower tPA in GDM compared to control groups, but the results were not significant statistically. Overall, the results of prior studies are quite ambiguous to interpret.…”

“…However, with commonly encountered pathologies during pregnancy, a more pronounced exacerbation of this hypercoagulable profile is documented. [20,21] We designed this retrospective observational cohort study to investigate the trimester specific reference range for DD throughout normal pregnancy, and to compare the distribution of DD in third trimester healthy pregnancies and those complicated by PE, SPE, GDM, PROM, and PPROM. In addition, we aimed to determine the diagnostic value of DD in PE and SPE.…”

Proteomics Analysis of Serum Proteins in Gestational Diabetes

“…The occurrence of diabetes enhances the activation of platelets and coagulation factors [12]. It was reported that the levels of prothrombin time and activated partial thrombin time of GDM patients were signi cantly lower than those of the non-pregnant group and healthy pregnancy group, whereas brinogen and plasminogen levels in GDM patients were markedly increased [13]. Here, we found that alpha-2-macroglobulin (A2MG) and brinogen alpha chain (FIBA) were down-regulated in the GDM group.…”

The relationship between insulin sensitivity and serum antithrombin 3 activity in patients with type 2 diabetes

“…T2D is associated with a hypercoagulable state, and patients with T2D are at a high risk of atherothrombotic events ( 15 , 16 ). Hyperglycemia, an extrinsic hallmark of T2D, together with dyslipidemia, obesity, aging, pregnancy, surgery and trauma may play a major role in the formation of a hypercoagulable state ( 17 , 18 , 19 ). Hyperglycemia was reported to be involved in the platelet activation, leukocyte aggregation, microparticles formation, endothelial dysfunction, impaired plaque remodeling, activation of coagulation and decreased fibrinolytic activity ( 20 ).…”