Factors predisposing to pre-eclampsia in women with gestational diabetes.
BACKGROUND
Lipid abnormalities occur before the onset of pre-eclampsia but their role in its pathogenesis is unclear. We tested the hypothesis that lipid abnormalities precede and contribute to the development of pre-eclampsia using women with gestational diabetes (GDM) as a focus population.


METHODS
One hundred and eighty-four women with a diagnosis of GDM were studied. Anthropometry, blood pressure, fasting lipids, glucose homeostasis, markers of inflammation and endothelial damage were measured and family history of disease was assessed to determine those measures at diagnosis of GDM that best predicted the development of pre-eclampsia.


RESULTS
Twelve percent of women with GDM developed pre-eclampsia. At diagnosis of GDM, total cholesterol, low-density lipoprotein and high-density lipoprotein cholesterol and triglycerides were not different in women who subsequently developed pre-eclampsia (GDM-PE). GDM-PE had elevated body mass index, blood pressure, fasting glucose, insulin, uric acid, and C-reactive protein (CRP), which have all been linked with the 'metabolic syndrome'. They had a greater degree of microalbuminuria and more frequently reported a family history of hypertension and maternal gestational diabetes. In logistic regression, the significant independent predictors for developing pre-eclampsia were fasting glucose, CRP, a family history of hypertension and the proband's mother having gestational diabetes.


CONCLUSIONS
The results suggest that, in GDM, increased severity of insulin resistance and related features of the 'metabolic syndrome', rather than lipid abnormalities, are precursors to the development of pre-eclampsia and hence are likely to be implicated in the pathophysiology of this disorder. Moreover, these women are likely to be at particularly high risk of long-term cardiovascular disease and Type 2 diabetes.
Barden
Anne
A
Cardiovascular Research Centre, School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia. abarden@cyllene.uwa.edu.au
Singh
Ravinder
R
Walters
Barry N
BN
Ritchie
Jackie
J
Roberman
Brian
B
Beilin
Lawrence J
LJ
D000328:Adult; D000886:Anthropometry; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D016640:Diabetes, Gestational / Q000097:blood / Q000150:complications* / Q000235:genetics / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008055:Lipids / Q000097:blood; D016015:Logistic Models; D008499:Medical Records; D009504:Neutrophils / Q000473:pathology; D010976:Platelet Count; D011225:Pre-Eclampsia / Q000097:blood / Q000209:etiology* / Q000652:urine; D011237:Predictive Value of Tests; D011247:Pregnancy; D012307:Risk Factors
D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids; D002097:C-Reactive Protein