PERSISTENT ELEVATION AND METABOLIC DEPENDENCE OF CIRCULATING E-SELECTIN AFTER DELIVERY IN WOMEN WITH GESTATIONAL DIABETES-MELLITUS

The increased risk of premature atherosclerosis in noninsulin-dependen t diabetes mellitus (NIDDM) might be related in part to augmented expr ession of endothelial adhesion molecules (AMs). So far it is, however, unknown whether increased circulating (c) AMs in NIDDM are only a con sequence of this disease or also involved in its sequelae. To determin e the presence of cAMs in a population at increased risk for subsequen t development of NIDDM, we analyzed fasting and postprandial [oral glu cose tolerance test (OGTT): 100 g] serum concentrations of circulating E-selectin, vascular cell adhesion molecule-1 (cVCAM-1), and intercel lular adhesion molecule-1 (cICAM-1) in pregnant women with either gest ational diabetes (GDM) or normal glucose tolerance (NT) before and aft er delivery vs. nonpregnant healthy women (C). During pregnancy cE-sel ectin and cVCAM-1 were elevated in both GDM and NT vs. nonpregnant fem ales (P < 0.01 vs. C). Following delivery, all GDM females regained no rmal glucose tolerance according to OGTT criteria, but showed slightly higher postprandial [area under the curve (AUC)(180 min)] glycemia an d HbA1c values than nonpregnant healthy women (P < 0.05), indicating p ersisting subtle abnormalities in carbohydrate metabolism. cE-selectin and cVCAM-1 remained increased in GDM (P < 0.01 vs. C) after delivery , but fell to normal in NT (P < 0.05 before vs. after delivery). Furth ermore, a correlation was seen in GDM females between cE-selectin and HbA1c (P < 0.005), fasting glucose (P < 0.01), and insulin (P < 0.05) as well as postprandial (AUC(180 min)) glucose and insulin concentrati ons (P < 0.05) during OGTTs, both before and after delivery. ICAM-1, h owever, did not differ significantly between groups. In summary, GDM i s characterized by persistently raised levels of cE-selectin and cVCAM -1 12 weeks after delivery. Whether these persistent elevations of cE- selectin and cVCAM-1 reflect early vascular injury or represent a risk factor for atherosclerosis in women at increased risk for NIDDM remai ns to be determined.