Department of Obstetrics and Women's Diseases, Karol Marcinkowski University of Medical Sciences, ul. Polna 33, Poznan, Poland.
Diabet Med. 2011 Jun;28(6):692-8. doi: 10.1111/j.1464-5491.2011.03249.x.
Some authors consider the vascular endothelium to be a target organ in diabetes. However, there have only been a few studies of the function of the maternal endothelium during pregnancy in women with diabetes. We analysed the relationship between maternal vascular endothelial dysfunction and fetal growth in such pregnancies.
Markers of endothelial dysfunction (serum concentration of sE-selectin and sVCAM-1) were measured at admission (baseline) and before delivery in 97 women with pregestational diabetes and a singleton pregnancy,. After delivery, the group with pregestational diabetes was divided retrospectively according to neonatal birthweight into three groups-appropriate, small and large for gestational age- and the maternal variables were analysed in relation to birthweight.
The baseline concentration of sE-selectin was significantly higher in the large-for-gestational-age group vs. the small-for-gestational-age group (median: 53.1 vs. 39.0 ng/ml, P<0.05). The concentration of sVCAM-1 at baseline was significantly higher in the small-for-gestational-age vs. the appropriate- and large-for-gestational-age groups (median: 846.2 vs. 576.8 and 524.1 ng/ml, respectively; P<0.01 and P<0.001, respectively). The concentration of sE-selectin at baseline and gestational changes in the concentration of sVCAM-1 were related to birthweight. The baseline concentrations of sE-selectin and sVCAM-1 and the gestational change in sVCAM-1 concentration were predictive factors for large for gestational age (cut-off values: 45.0, 644.6 and 38.4 ng/ml; sensitivity: 67.7, 89.3 and 34.4%; specificity: 65.5, 39.7 and 85.5%, respectively).
Our study showed a relationship between maternal endothelial dysfunction and fetal growth disturbances during pregnancy in women with diabetes that was not associated with maternal metabolic control. Higher levels of maternal sE-selectin in early pregnancy were associated with increased risk of the large-for-gestational-age condition. High levels of maternal sVCAM-1 in early pregnancy were characteristic of gestation complicated by the small-for-gestational-age condition. Further studies in larger groups are warranted to determine whether markers of maternal endothelial dysfunction are of use in the prediction of abnormal birthweight (large or small for gestational age) in pregnant women with diabetes.
一些作者认为血管内皮细胞是糖尿病的靶器官。然而，只有少数研究探讨了糖尿病孕妇孕期母体内皮功能与胎儿生长之间的关系。本研究分析了母体血管内皮功能障碍与糖尿病孕妇胎儿生长之间的关系。
97 例患有孕前糖尿病且单胎妊娠的孕妇于入院时（基线）及分娩前检测内皮功能障碍标志物（血清可溶性 E-选择素和可溶性血管细胞黏附分子-1 浓度）。分娩后，根据新生儿出生体重，回顾性将孕前糖尿病组分为适于胎龄儿、小于胎龄儿和大于胎龄儿 3 组，并分析母体变量与出生体重的关系。
基线时，大于胎龄儿组 sE-选择素浓度明显高于小于胎龄儿组（中位数：53.1 比 39.0ng/ml，P<0.05）。基线时，sVCAM-1 浓度在小于胎龄儿组明显高于适于胎龄儿组和大于胎龄儿组（中位数：846.2 比 576.8 和 524.1ng/ml，P<0.01 和 P<0.001）。基线 sE-选择素浓度及 sVCAM-1 浓度的妊娠变化与出生体重有关。基线 sE-选择素和 sVCAM-1 浓度及 sVCAM-1 浓度的妊娠变化是预测大于胎龄儿的因素（临界值：45.0、644.6 和 38.4ng/ml；敏感性：67.7%、89.3%和 34.4%；特异性：65.5%、39.7%和 85.5%）。
本研究显示，糖尿病孕妇孕期内皮功能障碍与胎儿生长紊乱之间存在关联，而与母体代谢控制无关。孕早期较高的 sE-选择素水平与大于胎龄儿的风险增加相关。孕早期较高的 sVCAM-1 水平是小于胎龄儿妊娠的特征。需要进一步在更大的研究群体中确定母体内皮功能障碍标志物是否可用于预测糖尿病孕妇异常出生体重（大于胎龄儿或小于胎龄儿）。
