Characterization of the metabolic syndrome in the gestational diabetes mellitus

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Morimitsu, Lilian Kanda [UNIFESP]
Bertini, Ana Maria [UNIFESP]
Dib, Sergio Atala [UNIFESP]
Nakamura, Mary Uchiyama [UNIFESP]
Antsaklis, Aris
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The importance of the recognition of Gestational diabetes mellitus (GDM) stems from fetal morbidity (mainly macrossomia) and from the fact that it's an independent predictor of type 2 Diabetes mellitus (DM2). DM2 and perhaps, GDM are a part of the Metabolic Syndrome. Maybe hypercoagulability could be added to this Syndrome. In our study, we analysed 54 pregnant women with GDM and 28 normal one (N). They were recruited between 28 and 34 weeks of gestation period. GDM had higher BMI before pregnancy (N vs. GDM; 22,3+/-3,7 kg/m(2) vs. 28,2+/-5,5; p<0,01), lower levels of HDL (65,8+/-14,6 mg/dl vs.58,7+/-14,3; p=0,04), higher levels of triglycerides (168,7+/-75,7 mg/dl vs. 219,6+/-75,7; p=0,001), leptin (18,2+/-12,6 ng/ml vs. 24,3+/-13,2; p=0,005) and lower HOMA S (%) (78,7+/-33,4 % vs. 65,5+/-35,6; p=0,04). Twenty three previous GDM women (40%) and 11 normal one (43%) returned 16 - 24 weeks after the delivery for the reavaliation. At this time, after new OGTT, in according to degree of glucose tolerance they were divided in three groups: Normal to Normal (N-NGT), GDM to Normal (GDM-NGT), GDM to impaired (GDM-IGT). Women with previous GDM had a higher waist to hip ratio (N-NGT vs. GDM-MGT vs. GDM-IGT; 0,84+/-0,04 vs. 0,85+/-0,06 vs. 0,89+/-0,06; p=0,03), higher levels of total cholesterol (161,8+/-25,4 mg/dl vs. 202,3+/-34,1 vs. 202,2+/-37,0; p=0,008), LDL (95,2+/-25,9 mg/dl vs. 116,0+/-41,6 vs. 134,2+/-31,0; p=0,02), triglycerides (65,0+/-18,0 mg/dI vs. 115,5+/-59,6 vs. 115,2+/-52,4; p=0,02), Plasminogen Activator Inhibitor Type 1 (PAI-1) (6,3+/-5,9 ng/ml vs. 13,7+/-15,4 vs. 27,2+/-23,1; p=0,0 1), lower HOMA B (%) (141,0+/-23,0 % vs. 120,8+/-27,0 vs. 87,5+/-44,0; p=0,002) and HOMA S (%) (65,0+/-20,0% vs. 78,2+/-21,0 vs. 46,2+/-17,0; p=0,01). PAI-1 during pregnancy has shown correlation (p<0,05) to fasting C-peptide levels (rs=0,38) and after delivery to total cholesterol (rs=0,37), leptin (rs=0,37), triglycerides (rs=0,48), VLDL (rs=0,47), LDL (rs=0,4 1), glycemia 0'(OGTT) (rs=0,52), glycemia 120'(OGTT) (rs=0,58), HbAlc (rs=0,41), waist to hip ratio (rs=0,44) and BMI after delivery (rs=0,34). PAI-1 had negative correlation (p<0,05) to HOMA S (rs=-0,42) and HOMA B (rs=-0,38). Leptin levels during pregnancy had correlation (p<0,05) to triglycerides (rs=0,35), VLDL (rs=0,38). After delivery, leptin had correlation (p<0,05) to waist to hip ratio (rs+0,32), glycemia 0'(OGTT) (rs=0,35) and 120'(OGTT) (rs=0,42), triglycerides (rs=0,40), fasting C peptide (rs=0,61), BMI after delivery (rs=0,74) and PAI-1 (rs=0,37). Leptin had negative correlation (p<0,05) to HOMA S (rs=-0,54). We conclude that many of the Metabolic Syndrome features were present in women with GDM during and after gestation. Eight of 23 previous GDM women had diabetes in our early metabolic assessment after delivery. These women had the lowest beta-cell function during pregnancy (N-NGT vs. GDM-NGT vs. GDM-IGT vs. GDM-DM; 202,9+/-57,7 vs. 196,4+/-50,3 vs. 174,0+/-43,6 vs. 103,8+/-31,7; P=0,0006) and a lower insulin sensitivity after delivery. Fasting PAI-1 and leptin levels, also in this condition, had a great correlation with insulin resistance parameters.
Proceedings Of The Xix European Congress Of Perinatal Medicine. Bologna: Medimond Publishing Co, p. 223-238, 2004.