CIRCULATING CELL-ADHESION MOLECULE CONCENTRATIONS IN DIABETIC WOMEN DURING PREGNANCY

Objective: To determine whether circulating concentrations of defined cell adhesion molecules, which are thought to reflect endothelial expr ession, are increased in insulin-dependent diabetic women during pregn ancy. Methods: Pregnant diabetic women demonstrating good glycemic con trol and without major complications before pregnancy were studied at 8-12 (n = 15), 18 (n = 15), 28 (n = 16), 32 (n = 16), and 36 (n = 16) weeks' gestation. A subgroup of ten diabetic women was sampled longitu dinally through all five gestational ages. The diabetic women were com pared with healthy nondiabetic women sampled cross sectionally at 12 ( n = 20), 28 (n = 19), and 36 (n = 19) weeks' gestation. Nonpregnant di abetic (n = 22) and nonpregnant nondiabetic women (n = 28) also were s tudied. Plasma concentrations of the cell adhesion molecules E-selecti n, intercellular adhesion molecule-1 (ICAM-1), and vascular endothelia l cell adhesion molecule-1 (VCAM-1) were measured by enzyme-linked imm unosorbent assay. Results: Significantly higher median (range) concent rations of E-selectin (63.0 [20.2-107.0] ng/mL) and ICAM-1 (281.5 [171 .6-778.4] ng/mL) but not VCAM-I (459.7 [301.0909.7] ng/mL) were found in nonpregnant diabetic women compared with nonpregnant nondiabetic wo men (43.5 [18.193.2], 243.6 [174.4-329.2], and 476.0 [253.8-929.4] ng/ mL, respectively). During pregnancy these significant differences betw een diabetic and control groups were lost. The median (range) concentr ation of E-selectin (50.0 [21.2-96.3] ng/mL) was significantly lower i n pregnant compared with nonpregnant diabetic women. The plasma concen trations of E-selectin and ICAM-1 did not change significantly with ge station in either diabetic or nondiabetic pregnant groups. Vascular en dothelial cell adhesion molecule-1 concentration changed significantly with gestation in the diabetic pregnant group only. Conclusion: Circu lating concentrations of defined vascular cell adhesion molecules are not increased abnormally in women with good glycemic control during ot herwise uncomplicated pregnancy. (C) 1997 by The American College of O bstetricians and Gynecologists.