Features of the functional state of the endothelium and the hemocoagulation system in the formation of placental insufficiency in patients with gestational diabetes mellitus without insulin requirement

Abstract

Background. There is a lot of data in the literature showing the state of the hemostatic system and endothelium separately in patients with gestational diabetes mellitus (GDM) and placental insufficiency (PI). However, with the combination of the above complications of pregnancy, there is very little research, therefore, the problem requires detailed study.Objective. To determine the contribution of the functional state of the endothelium and the hemocoagulation system to the formation of placental insufficiency in patients with gestational diabetes mellitus without insulin requirement.Materials and methods. A longitudinal cohort comparative study was conducted. The study included 120 patients in the II-III trimester of pregnancy with GDM without insulin requirement. The main group consisted of 70 women whose pregnancy was complicated by sub- and decompensated forms of PN. The comparison group included 50 pregnant women without pathology of the fetoplacental complex. The hemostasis system was studied using clotting tests and thromboelastometry. The concentrations of VEGF-A, total nitrite (NO2 total), endogenous nitrite (NO2 endogenous), nitric oxide (NO) in peripheral blood were determined by ELISA. Comparison of continuous quantitative data was carried out using the Mann-Whitney test, which was calculated using the MedCalc 15.8 application program. The null hypothesis was rejected at p<0.05.Result. The value of the integral index of coagulation, onset time and initial speed of clot formation in the main group was statistically significantly higher than in patients in the comparison group, p<0.05. The level of VEGF-A in pregnant women of the main group was statistically significantly lower than that in the comparison group, p<0.05. The indicator of total NO2 and NO in the main group was statistically significantly lower than in the comparison group, p<0.05. The endogenous NO2 indicator did not differ statistically significantly between groups.Conclusion. In patients with GDM on diet therapy and PN, endothelial dysfunction and, as a consequence, hypercoagulation occur.