Inflammatory markers and retinopathy in pregnancies complicated with type I diabetes.
OBJECTIVE
The relation of maternal cytokine levels to retinopathy progression during diabetic pregnancy is a less studied subject. Therefore, we investigated levels of systemic proinflammatory markers, C-reactive peptide (CRP), interleukin-6 (IL-6) and circulating vascular cell adhesion molecule-1 (VCAM-1) during pregnancy and postpartum in relation to the progression of diabetic retinopathy (DR).


METHODS
A prospective follow-up study of 39 pregnant women with Type I diabetes and eight nondiabetic pregnant women was performed. DR was graded from fundus photographs. Plasma levels of systemic proinflammatory markers were measured by immunofluorometric assay (CRP) and by enzyme-linked immunosorbent assay (IL-6 and VCAM-1) in the first, second (diabetics only), third trimester of pregnancy, and 3 and 6 months postpartum (diabetics only).


RESULTS
Our diabetic women had good glycaemic control (HbA1c 6.9 +/- 0.8). The levels of IL-6, VCAM-1, and CRP did not differ between diabetic and nondiabetic women throughout pregnancy and postpartum (repeated measures ANOVA between the groups). An association between CRP and progression of retinopathy was observed in diabetic women (P = 0.037). Additional evidence of inter-relationship could be revealed as CRP was higher in those diabetic women with worse glycaemic control (HbA1c) (P = 0.038).


CONCLUSIONS
During pregnancy and postpartum, levels of proinflammatory factors (IL-6, CRP, VCAM-1) seem to be generally similar in Type I diabetic women compared to nondiabetic controls. However, CRP levels were higher in those diabetic women with progression of retinopathy and in those with worse glycaemic control.
Department of Ophthalmology, Helsinki University, Central Hospital Helsinki, Haartmaninkatu 4 C, FIN-00290 Helsinki, Finland. sirpa.loukovaara@hus.fi
S
S
Loukovaara
I
I
Immonen
R
R
Koistinen
V
V
Hiilesmaa
R
R
Kaaja
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D002196:Capillaries / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000097:blood* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D016015:Logistic Models; D008833:Microcirculation; D049590:Postpartum Period / Q000097:blood; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000503:physiopathology; D012171:Retinal Vessels / Q000503:physiopathology; D012720:Severity of Illness Index; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D002097:C-Reactive Protein; D006442:Glycated Hemoglobin; D018836:Inflammation Mediators; D015850:Interleukin-6; D019010:Vascular Cell Adhesion Molecule-1