781 Association between leptin, C-Peptide, Vascular-Endothelial-Growth-Factor (VEGF), Placental-Growth-Factor (PIGF) and hypertensive disease in women with Type-2-Diabetes-Mellitus

Abstract

To determine the association between maternal third trimester leptin, c-peptide, VEGF, and PIGF and hypertensive disorders of pregnancy (HDOP) among women with type 2-diabetes mellitus (T2DM). Case-control study of data from a multicenter RCT of pregnant women with T2DM randomized to insulin plus metformin or insulin alone. Women were enrolled between 10 and 23 weeks’ gestation and blood collected between 24 and 30 weeks’ gestation. We measured maternal serum leptin, c-peptide, VEGF, and PIGF levels and defined our primary outcome of hypertensive disorder of pregnancy (HDOP) as new onset systolic BP above 140, or diastolic BP above 90 at least 4 hours apart. We determined the association between third trimester maternal serum levels and HDOP, delivery, and neonatal outcomes using t-test, chi-square, and multivariable logistic regression as appropriate and considered P<0.05 statistically significant. We have data on 236 women, 84 (36%) cases and 152 (64%) controls. Compared to controls, cases were more likely to identify as African American (44.1% vs. 29.6%, p=0.03) or have chronic hypertension (33.3% vs. 19.7%, p=0.02) (Table 1). Additionally, cases delivered earlier (mean 36.2 (SD 2.6) vs. 37.0 (SD 2.7) weeks, p=0.03) and were more likely to have 5 minute APGAR <7 (31% vs. 15.8%, p=0.006). Serum leptin, c-peptide, VEGF, and PIGF were not significantly different between cases and controls (Table 1). In regression models, serum leptin, c-peptide, VEGF, or PIGF were not significantly associated with HDOP. Within the cohort overall, mothers of newborns requiring NICU admission or oxygen supplementation had significantly higher leptin levels (p=0.005, p=0.004, respectively). C-Peptide levels were significantly higher among mothers of neonates with 5 minute APGAR <7 (p=0.02) (Table 2). In women with T2DM, third trimester leptin and c-peptide levels may impact immediate neonatal birth outcomes, particularly respiratory drive. A larger sample size (n=352) would be powered to detect a leptin-mediated difference in outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)