Fibrinolytic dysfunction after gestation is associated to components of insulin resistance and early type 2 diabetes in latino women with previous gestational diabetes
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2007-12-01
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Among patients with metabolic syndrome (MS), atherosclerosis and abnormal fibrinolytic function are frequently present, mostly owing to an increase in plasminogen activator inhibitor-1(PAI-1). We analyze PAI-1 in pregnant women, both normal and with gestational diabetes (GDM) and postpartum regarding its correlation to MS surrogates. Clinical characteristics, glucose tolerance (100 g-OGTT), lipids, PAI-1 antigen, insulin sensitivity (HOMA-S), and pancreatic P-cell function (HOMA-B) were investigated in 34 women. Eleven had normal glucose tolerance (NGT) during pregnancy and 23 had GDM (all GAD antibodies-negative). All patients were studied at 28-34 weeks of gestation and 16-24 weeks after delivery (75 g-OGTT). Parameters of interest were determined using commercial test systems. During pregnancy, PAI-1 was not statistically different between NGT and GDM (47 +/- 25 ng/ml versus 47 +/- 28 ng/ml, p = 0.9). After gestation, 19 (56%) women had NGT (11 of them from previous NGT A group) and 15 (44%) had impaired glucose tolerance (IGT) or DM. the IGT (IGT + DM) group had higher PAI-1 (p = 0.01), which did not decreased after delivery NGT-NGT before and after delivery (47 +/- 25 ng/ml versus 6 +/- 5 ng/ml; p < 0.001), GDM-NGT (62 +/- 36 ng/ml versus 14 +/- 15 ng/ml; p = 0.001) and GDM-IGT (39 +/- 20 ng/ml versus 27 +/- 23 ng/ml; p = 0. 15). PAI-1 levels were positively correlated (p < 0.05) to total cholesterol (r, = 0.37), triglycerides (r,, = 0.48), fasting plasma glucose (r(s), = 0.52), 2-h plasma glucose in the OGTT (r(s) = 0.58) and were negatively correlated (p < 0.05) with HOMA-S (rs = -0.42) and HOMA-B (r, = -0.38). Fibrinolytic dysfunction is still present in GDM women and is associated with early development of IGT or T2DM. PAI correlated with surrogate markers of MS levels and may identify a group of women at risk for macroangiopathy. (c) 2007 Elsevier Ireland Ltd. All rights reserved.
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Diabetes Research and Clinical Practice. Clare: Elsevier B.V., v. 78, n. 3, p. 340-348, 2007.