Prothrombotic risk factors in infants of diabetic mothers.
BACKGROUND
Infants of diabetic mothers (IDMs) are at an increased risk for thromboembolic disease. The mechanism(s) to explain this association is unclear. We hypothesized that the pathophysiology of thrombosis in IDMs is multifactorial and likely involves interactions among genetic and acquired factors affecting the procoagulant, anticoagulant and fibrinolytic pathways.


OBJECTIVE
To compare the prevalence of common prothrombotic risk factors in a cohort of IDMs to a matched control group.


METHODS
Full-term infants born to mothers with diet controlled (A1-IDM) (N=17), insulin requiring diabetes (ID-IDM) (N=20) and healthy term infants (controls) (N=20) matched for mode of delivery had cord blood collected at delivery. Samples were analyzed for the following: factor V Leiden (FVL), prothrombin 20210A (P20210A), methylenetetrahydrofolate reductase C677 T (MTHFR), Factor VIII (FVIII), Protein C (PC), Lipoprotein(a) (Lp(a)) and plasminogen activator inhibitor-1 (PAI-1).


RESULTS
None of the infants had a clinically apparent thrombotic event. IDM mothers and their infants were clinically similar to controls except for a higher prevalence of hypoglycemia (30 vs 0%; p=0.005). There was no significant difference in the prevalence of the common genetic risk factors (FVL, P20210A, MTHFR) FVIII, or PAI-1 levels. Elevated Lp(a) levels were seen more frequently in IDMs than Controls (40 vs 20%) but this difference was not statistically significant. The PC activity (%) was significantly decreased in the IDM group compared to controls, 35+/-12 vs 44+/-9 (p<0.005). A1-IDM had lower PC activity compared to ID-IDM (p=0.05) and controls (p=0.001).


CONCLUSIONS
PC deficiency is likely one mechanism to explain thrombosis in IDMs.
Sarkar
Shikha
S
Department of Pediatrics, Division of Neonatology (S.S., V.C.H.), Connecticut Children's Medical Center, Hartford, CT 06106, USA.
Hagstrom
Nathan J
NJ
Ingardia
Charles J
CJ
Lerer
Trudy
T
Herson
Victor C
VC
D001779:Blood Coagulation Factors / Q000032:analysis; D016022:Case-Control Studies; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D016640:Diabetes, Gestational / Q000097:blood*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry*; D006801:Humans; D007231:Infant, Newborn; D017270:Lipoprotein(a) / Q000097:blood; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000097:blood; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood*; D011486:Protein C / Q000032:analysis; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology
D001779:Blood Coagulation Factors; D017270:Lipoprotein(a); D011486:Protein C; D042965:Methylenetetrahydrofolate Reductase (NADPH2)