Résumé
Gestational diabetes is characterized by glucose intolerance first recognized during pregnancy. Women with gestational diabetes are more prone to develop type II diabetes later in life. The increased risk of premature endothelial dysfunction with hyperglycemia might be related in part to augmented expression of cell adhesion molecules. Diabetes is also characterized by oxidative stress which in turn determines endothelial dysfunction via nitric oxide synthase linked pathway. Aim: To evaluate the effect of gestational diabetes on the adhesive molecules and status of oxidative stress. Subjects and Five hundred and eighty seven pregnant women [24-28 weeks of gestation] with no risk factors and normal renal and liver functions were tested for serum glucose by screen test and-when necessary- glucose tolerance curve. Thirty three cases [5.6%] who have gestational diabetes constituted the patients group. Twenty healthy pregnant women with negative screen test and glucose tolerance curve were taken as a control group. Both patients and controls were investigated for serum E- selectin, VCAM-1, endothelin-1, nitric oxide, lipid peroxidation and superoxide dismutase [SOD], during gestation and after delivery. During gestation, sE-selectin was higher and sVCAM-1 was lower in diabetic cases than controls but with no significant differences, while significant elevations of lipid peroxidation [p < 0.01] and SOD [p < 0.001] in patients group compared to control group. Three months after delivery, significant elevations of sE-selectin [p < 0.001], sVCAM-1 [p < 0.001], and SOD [p < 0.001] were observed in women with gestational diabetes compared to the controls. There were significant reduction in lipid peroxidation and SOD [p < 0.001] in the patients after delivery as compared to that during pregnancy, while sE-selectin, sVCAM-1 and NO were higher after delivery than during pregnancy but the difference was statistically insignificant. The controls showed significant decrease in levels of endothelin-1, sE-selectin and sVCAM-l with longitudinal follow up. The follow up study revealed that six cases [patients group A] continued with impaired glucose toerance curve [31.6%] and thirteen cases [patients group B] returned with normal glucose curve. In group A, there were significant elevation of E-selectin [p < 0.05] and significant decrease of endothelin-l [p < 0.01] as compared to group B, while NO and SOD were reduced but the difference was statistically insignificant. Sustained elevations of sE-selectin and sVCAM-1 in cases with gestational diabetes even after delivery may reflect vascular injury or risk factor for endothelial dysfunction. Furthermore the elevations of lipid peroxidation and SOD in the patients group during pregnancy may be implicated this pathogenesis of gestational diabetes and may be considered as sensitive indicators of oxidative stress in gestational diabetes