Endocrine Abstracts

Type 1 diabetes mellitus (T1DM) and preeclampsia (PE) in pregnant women share common pathophysiological pattern (hypovolemia, increased vascular resistance, and kidney damage) and both are genetically determined. Genetic impact on PE development and aggravation of insulin resistance in T1DM pregnant women has been underinvestigated. Thus, the aim of this case-control study was to evaluate the influence of ACE gene I/D polymorphism on risk of PE and insulin resistance development.

Materials and methods: Inclusion criteria were as following: for group I – T1DM with superimposed PE (30 patients) and for group II – DM without PE (30 patients). Standard examination was undertaken during pregnancy and postpartum, as well as detection of ACE gene polymorphism with allele-specific PCR. The obtained results were analysed using STATISTICA 10.0 Software.

Results: Patients of group II had significantly higher prevalence (χ²=10.35; P<0.01) of II genotype compared to group I (56.7 and 16.7% respectively) supporting the protective effect of II genotype on PE development in the investigated population (OR=0.15; 95% CI 0.05–0.51). Fasting lucose levels (per se and in relation to different genotypes) didn’t differ between both groups before PE appearance, as well as prior to delivery. But in group I we detected elevated glucose levels depending on genotypes: 8.72±1.26 mmol/l – in patients with DD genotype, 8.72±1.26 mmol/l – in patients with ID genotype, 5.93±0.52 mmol/l – in women II genotype. In group I differences in glucose levels reported in patients with II genotype compared to patients with DD and ID genotypes were found to be statistically significant (P<0.05). Other parameters supporting deeper insulin resistance aggravation have been identified prior to delivery only among patients of group I with DD and ID genotypes.

Conclusion: ACE gene polymorphism determines the risk of PE in pregnant women with T1DM and modulates unfavourable course of the disease, particularly, aggravation of insulin resistance in patients with DD and ID genotypes.