The role of nitric oxide, endothelin-1, and prostaglandins in the pathogenesis of gestational diabetes

Studying the pathophysiological mechanisms of gestational diabetes (GD) will enable more accurate prediction of the development of this condition, its adverse perinatal and long-term metabolic consequences. Aim - assessment of the role of nitric oxide (NO), endothelin-1 (Et-1), and prostaglandins in the pathogenesis of GD. Materials and methods. Between 2020 and 2023, a comprehensive examination of 120 pregnant women was conducted. The study group included 90 patients with GD, while 30 women with physiological pregnancies formed the control group. Blood samples from all study participants were analyzed for levels of NO, L-arginine, thromboxane B2 (TxB2), Et-1, and prostaglandins E2 (PGE2), F2α (PGF2α), and prostacyclin (PGI2) using enzyme-linked immunosorbent assays on a "Sunrise" analyzer from Tecan. Results. The levels of PGE2 and PGI2 in pregnant women with GD were significantly lower than those in healthy women, and PGF2α and ThB2, on the contrary, were significantly higher. The ratio of prostaglandins PGE2α/PGE2 in pregnant women with GD was 0.36, which was more than 4 times higher than that in healthy women. The ratio of ThB2/PGI2 in pregnant women with GD was 1.52, which was more than 3 times higher than that in healthy women. Multinomial logistic regression models were constructed to predict the occurrence of GD and determine the most sensitive and specific indicator, which included a comprehensive analysis of body weight, heredity, as well as determining the levels of biomarkers such as Et-1, NO, PGF2α, PGE2. Conclusions. The observed endothelial dysfunction may be a key mechanism underlying the development of preeclampsia and diabetic fetopathy in GD patients, as supported by the multinomial logistic regression models. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the local ethics committee of the participating institution. Informed consent was obtained from all patients. No conflict of interests was declared by the authors.