Gestational diabetes mellitus is associated with antenatal hypercoagulability and hyperfibrinolysis: a case control study of Chinese women

To determine the relationship between gestational diabetes mellitus (GDM) and coagulation/fibrinolysis abnormality in antenatal Chinese women. Case control study: 50 women had GDM and 132 did not (the NGDM group) grouping by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Maternal plasma biochemistry and previous medical history were collected from perinatal health records. Antenatal coagulation/fibrinolysis activity (CFA) parameters were assessed using thromboelastography and routine CFA parameters, respectively. Univariate and multiple regression analyses were used to evaluate the associations between GDM and CFA parameters. Maternal age, platelet, ALT, ALP, urea nitrogen, and previous history of abortion were taken as the covariables. The women with GDM were significantly older than those without GDM (30.3 vs. 28.6 years, <i>p</i> = .012). Compared with the NGDM group, the GDM group had a significantly higher prevalence of cesarean delivery (56.0 vs. 37.9%, <i>p</i> = .027) and higher values of fibrinogen (FIB; 4.7 vs. 4.3 g/L, <i>p</i> = .001), activated partial thromboplastin time (APTT; 30.9 vs. 29.5 s, <i>p</i> = .010).There were no significant differences in the prevalence of maternal thrombotic events or neonatal events. GDM was significantly associated with higher APTT (<i>β</i> =1.41 s, 95% CI: 0.29–2.53), higher FIB (<i>β</i> = 0.38 g/L, 95% CI: 0.14–0.61), and higher percentage reduction in clot lysis after 30 min (LY30; <i>β</i> = 1.14%, 95% CI: 0.15–2.13) after adjustment for potential confounding factors. GDM is significantly associated with hypercoagulability and hyperfibrinolysis in these antenatal Chinese women.为探讨中国产前妇女妊娠期糖尿病（gestational diabetes mellitus, GDM）与凝血/纤溶异常的关联。本研究为病例对照研究，按照国际糖尿病与妊娠研究组协会（International Association of Diabetes and Pregnancy Study Groups, IADPSG）的诊断标准，将研究对象分为50例GDM患者组与132例非GDM对照组（NGDM组）。从围产期健康档案中提取研究对象的血浆生化指标与既往病史信息。分别采用血栓弹力图与常规凝血/纤溶活性（coagulation/fibrinolysis activity, CFA）检测方法，评估产前妇女的CFA参数。采用单因素与多重回归分析，探究GDM与CFA参数之间的关联；以产妇年龄、血小板计数、谷丙转氨酶（ALT）、碱性磷酸酶（ALP）、尿素氮及既往流产史作为协变量。GDM组产妇的平均年龄显著高于非GDM组（30.3岁 vs 28.6岁，p=0.012）。与非GDM组相比，GDM组的剖宫产率显著更高（56.0% vs 37.9%，p=0.027），且纤维蛋白原（fibrinogen, FIB）水平（4.7 g/L vs 4.3 g/L，p=0.001）、活化部分凝血活酶时间（activated partial thromboplastin time, APTT）（30.9s vs 29.5s，p=0.010）均显著升高。两组产妇血栓事件发生率与新生儿事件发生率均无显著差异。在校正潜在混杂因素后，GDM与更高的APTT（β=1.41s，95%置信区间：0.29~2.53）、更高的FIB水平（β=0.38g/L，95%置信区间：0.14~0.61）以及更高的30分钟血块溶解率（LY30；β=1.14%，95%置信区间：0.15~2.13）均存在显著关联。本研究结果显示，在中国产前妇女中，GDM与高凝状态及纤溶亢进显著相关。