Endocrine Abstracts

Objectives: We investigated in women with prior GD (pGD) at risk of diabetes and premature atherosclerosis in comparison to women with normal glucose tolerance during and after pregnancy (C) parameters of inflammation, endothelial dysfunction and glucose tolerance in a follow-up study.

Methods: 119 pGD and 41 C underwent an oral glucose tolerance test 3 months, 1 and 2 years after delivery with measurements of plasma concentrations of circulating adhesion molecules (cAMs: VCAM, ICAM-1, ELAM), endothelin, leptin, sCRP, IL-6, fibrinogen, PAI-1 and ADMA. Intima-media-thickness (IMT) of the common carotid artery was measured by ultrasound and insulin sensitivity (S_I) was calculated from insulin-modified FSIGTs at baseline.

Results: At baseline ICAM (P<0.0001), VCAM (P<0.005), ADMA (P=0.0005), sCRP (P=0.04) and PAI-1 (P=0.01) were higher and S_I (P=0.001) was lower in pGD than in C. S_I inversely related to all cAMs (r=−0.20; P<0.02), sCRP (r=−0.52; P<0.0001), IL-6 (r=−0.25; P=0.01), and fibrinogen (r=−0.22; P=0.006). All cAMs also related to leptin (r=0.17; P<0.04) and BMI (r=0.18; P<0.03). IMT was associated with S_I (r=−0.32; P=0.03), BMI (r=0.31; P=0.02) and PAI-1(r=0.30; P=0.03). After two years ELAM (P<0.02), ADMA (P<0.0007), PAI-1 (P<0.001), vWF (P<0.04), blood pressure (P<0.001) decreased, while ICAM-1, VCAM and BMI remained unchanged. Leptin (P=0.01), TNFα (P<0.001) and endothelin (P<0.04) increased compared to baseline. Higher age (P<0.05) and BMI (P<0.0001), increased levels of ELAM (P<0.003), Leptin (P<0.0005) and a lower insulin sensitivity (OGIS;P=0.01) at baseline characterised those pGD with deterioration of their initial normal glucose tolerance (n=15) in comparison to those who retained normal glucose tolerance (n=65) within 2 years. Logistic regression revealed BMI (OR[CI]: 1.313[1.03-1.67]) and ELAM (OR[CI]: 1.064[1.01-1.12]) as independent predictors of a deterioration of glucose tolerance.

Conclusion: Women with pGD are characterised by higher plasma ICAM and VCAM relating to insulin-resistance and inflammatory parameters. Moreover the degree of obesity and ELAM at baseline predicted deterioration of glucose tolerance within 2 years after delivery.