Abstract
BackgroundIf not detected and treated, gestational diabetes mellitus (GDM) can cause serious pregnancy complications such as macrosomia, preeclampsia, and fetal/neonatal mortality. Many studies have examined underlying contributing factors for GDM, including hypercoagulation. Factor XII (FXII) is a coagulation factor that increases throughout normal pregnancies, and we evaluated the relationship of GDM with FXII, FXIIa (activated FXII), and other coagulation parameter levels. GDM and macrosomia are closely related, but it is not known whether FXII could be an independent causal factor for macrosomia.MethodsIn this prospective study, blood samples were taken from 69 pregnant women at the time of term delivery to determine levels of FXII, FXIIa, and other coagulation parameters. Based on the results, pregnancies fell into GDM, non-diabetic with macrosomia (M), or healthy (C [control]).ResultsFXII concentration levels were significantly higher in GDM patients compared with the M and C groups. There were no significant differences when comparing FXIIa, activated partial thromboplastin time, prothrombin time (PT), and international normalized ratio. The GDM group saw a significant negative correlation between FXII concentrations and maternal pregestational body mass index (BMI) and BMI before delivery. In the M group, a positive correlation was observed between FXII concentrations and newborn weight and newborn weight percentile.ConclusionsAn increase in FXII levels was observed in patients with gestational diabetes. Associations between coagulation parameters and GDM should be further analyzed to define the mechanisms of GDM and possible treatment modalities.Trial registrationOur study has been registered at clinicaltrials.gov (NCT03583216). Registered on July 11, 2018,
Highlights
If not detected and treated, gestational diabetes mellitus (GDM) can cause serious pregnancy complications such as macrosomia, preeclampsia, and fetal/neonatal mortality
Ninety-eight women admitted to our obstetrics and gynecology clinic for delivery from July to November 2018 were assessed for study recruitment, and 69 met the inclusion criteria: 22 in the GDM group, 22 in the M group, and 25 in the control group (Fig. 1)
In the M group, a positive correlation was observed between Factor XII (FXII) concentrations, infant weight (r = 0.441, p = 0.04), and infant weight percentile (r = 0.60, p = 0.003); a negative correlation was observed between FXII concentrations, body mass index (BMI) before pregnancy (r = − 0.443, p = 0.039), and BMI before delivery (r = − 0.531, p = 0.011)
Summary
If not detected and treated, gestational diabetes mellitus (GDM) can cause serious pregnancy complications such as macrosomia, preeclampsia, and fetal/neonatal mortality. Factor XII (FXII) is a coagulation factor that increases throughout normal pregnancies, and we evaluated the relationship of GDM with FXII, FXIIa (activated FXII), and other coagulation parameter levels. Gestational diabetes mellitus (GDM) is a common pregnancy complication [1], with a 2016 US prevalence of 6%, according to the Centers for Disease Control and Prevention [2]. Factor XII (FXII, Hageman factor) is part of the normal coagulation system and increases in pregnant women with each week of gestation [9, 10]. The kallikreinkinin system is activated in uncontrolled or poorly controlled diabetic individuals, which increases the level of FXII [13]. FXII shows mitogenic activity in a zymogenic form; this might be related to macrosomia [14, 15], which itself can have adverse fetal, neonatal, and even adult outcomes
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