Features of the endothelial system in pregnant women with gestational diabetes

Pregnancy causes adaptive changes in a woman's body to support fetal development. Gestational diabetes is associated with impaired glucose metabolism and insulin resistance, which affects the endothelial vasculature and placental circulation and can lead to serious complications for both mother and child, including preeclampsia, preterm birth, and diabetic fetopathy. Aim - assessment of features of the endothelial system in pregnant women with different stages of gestational diabetes according to indicators of prostanoids (prostaglandins, prostacyclin and thromboxane), endothelin-1, L-arginine and nitric oxide. Materials and methods. Endothelial function was assessed using prostaglandin E2, prostaglandin F2α, prostacyclin, thromboxane B2, endothelin-1, nitric oxide and L-arginine in 120 pregnant women. The main group consisted of 90 patients with gestational diabetes, among whom 50 women had class A1 (subgroup I), and 40 women had class A2 (subgroup II). The control group included 30 women with a physiological course of pregnancy. Results. In women with gestational diabetes, a decrease in indicators of substances with a depressant effect was recorded when compared with healthy pregnant women: the level of prostaglandin E2 was 2.60±0.46 ng/ml against 5.91±0.37 ng/ml, prostacyclin - 57.8±1.32 pg/ml versus 101.8±10.3 pg/ml, nitric oxide - 2.1±0.4 γ/mol versus 3.5±0.5 γ/mol and L-arginine - 39.2±6.2 mmol/l versus 60.4±2.5 mmol/l. An increase in vasoconstrictor substances was noted: prostaglandin F2α in women of the main group was 0.9±0.4 ng/ml, in the control group - 0.42±0.04 ng/ml, thromboxane B2 - 75.4±17.2 pg/ml and 46.5±5.2 pg/ml, respectively, endothelin-1 - 17.2±5.4 pg/ml and 8.3±1.4 pg/ml, respectively. These changes were aggravated with insulin-dependent gestational diabetes and the addition of preeclampsia. Conclusions. Dysfunction of the endothelial system due to an imbalance between substances involved in the regulation of vascular tone and coagulation was found in pregnant women with gestational diabetes. Control of endothelial function in such women is important for timely detection and impact on possible complications. 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.