Coagulation and fibrinolysis variables in pregnant women with type 1 diabetes mellitus

Background; Many studies have reported changes in the hemostatic system in patients with type 1 diabetes in whom coagulation processes predominate over fibrinolytic activity. The aim of this study was to assess more of the hemostatic variales during pregnancy women with in type 1 diabetes. Material/Methods; The current study included 31 pregnant diabetic women and 24 healthy pregnant women. At. 12, 24, and 36 weeks of gestation, we determined blood concentrations of the following: platelet count, fibrinogen, tissue plasminogen activator antigen, and plasminogen activator inhibitor-1. Results: When we compared pregnant diabetic women in the third trimester with those in the first trimester, we observed a statistically significant decrease in the platelet count (172.0 +/- 9.0 vs 200.6 +/- 9.8 G/L, P < 0.05) and a statistically significant increase in the levels of fibrinogen (3.5 +/- 0.2 vs 2.9 +/- 0.2 g/L, P < 0.05), tissue plasminogen activator antigen (14.9 +/- 2.2 vs 4.7 +/- 0.6 ng/mL, P < 0.001) and plasminogen activator inhibitor-] (17.2 +/- 2.8 vs 4.0 +/- 1.0 IU/mL, P < 0.001). Similar fibrinogen, tissue plasminogen activator: A, and plasminogen activator inhibitor-1 changes were observed in pregnant women (3.8 +/- 0.3 vs 2.9 +/- 0.2 g/L, P < 0.05; 7.7 +/- 0.9 vs 5.2 +/- 0.3 ng/mL, P < 0.05; and 17.6 +/- 2.1 vs 5.1 +/- 1.1 IU/mL, P < 0.05, respectively). Tissue plasminogen activator antigen was the only variable to significantly increase during the third trimester in pregnant diabetic women with microangiopathy compared with women without microangiopathy (21.0 +/- 3.2 vs 8.4 +/- 1.7 ng/mL, P < 0.01). Conclusions: (1) In patients with type 1 diabetes without microangiopathy and with good metabolic control, fibrinogen and tissue plasminogen activator antigen concentrations and changes in the activity of plasminogen activator inhibitor-1 are similar to those found in patients with a normal pregnancy; (2) the marked decrease in platelet count in patients with type 1 diabetes during pregnancy may be an additional source of plasminogen activator inhibitor-1; and (3) during pregnancy, diabetic microangiopahty leads to a greater increase of tissue plasminogen activator antigen concentration as a marker of endothelial cell injury.