Predicting the Risk of Preeclampsia in Pregnant Women with Type 1 Diabetes Mellitus and Concomitant Diabetic Nephropathy: the Role of Genetic Markers
Introduction. Systematic reviews found that in diabetic nephropathy, there is a 2-fold risk of adverse effects for the fetus, and 5-fold — for the mother. Most complications in patients with diabetic nephropathy are mediated by the development of arterial hypertension (AH). Up to 45 % of mothers with diabetic nephropathy require delivery within the time frame to 34 weeks of pregnancy due to preeclampsia. Even in chronic kidney disease stage I, occurrence/presence of AH increases the risk of preterm birth by 3.4–7.24 times. The prediction of hypertensive disorders in pregnant women with diabetic nephropathy will help to take appropriate preventive measures promptly, to establish closer monitoring that, as a result, will improve maternal and perinatal outcomes of pregnancy in this group of women. Objective of the study: on the basis of clinical and laboratory parameters, profile of carriage of polymorphic variants of genes, as well as the nature of intergenic and gene-environment interactions to determine the favourable factors and their combinations, which would allow to predict the risk of preeclampsia in pregnant women with diabetes mellitus (DM) type 1 and concomitant diabetic nephropathy.
Materials and methods. The main group consisted of 30 patients with DM type 1 and preeclampsia (23 of them — with diabetic nephropathy), comparison group — of 30 patients with DM, whose pregnancy ran without preeclampsia (13 — with diabetic nephropathy). In all patients, we have studied 7 polymorphic variants of 5 genes: A1166S_AT2R1; C108T_PON1; Thr83Ala_ and T138C_MGP; 4b/4a_ and G894T_eNOS; I/D_ACE.
Results. If there is diabetic nephropathy, the development of preeclampsia was associated with the following factors: long duration of DM (> 14 years); the presence of diabetic retinopathy; 108ST genotype by PON1 gene, as well as ID- and DD-genotype for the ACE gene. Significant gene combinations were ACE + PON1, and MGP (Thr83Ala) + eNOS.
Conclusions. In patients with diabetes mellitus type 1 and concomitant diabetic nephropathy without hypertension, we can recommend to study these polymorphic variants of genes to determine the risk of preeclampsia.
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