HEALTH OF WOMAN.2015.10(106):28–36; doi 10.15574/HW.2015.106.28 

New approaches to early prediction of preeclampsia severity in pregnant women with type 1 diabetes mellitus: evaluation of the possibility of genetic markers’ use 

Avramenko T. V., Hrybanov A. V., Rossokha Z. I.

SI «Institute of Pediatrics, Obstetrics and Gynecology, NAMS of Ukraine», Kiev

City maternity hospital № 2, Nikolaev

SІ «The Reference center for molecular diagnosis of Ministry of health of Ukraine», Kyiv 

Overall 60 female patients with type 1 diabetes were investigated: pregnancy complicated with mild (n=15), moderate (n=11) and severe (n=4) superimposed preeclampsia was reported in 30 subjects (main study group); no complications were detected among the rest 30 patients (control group). Besides standard clinical investigation, each patient underwent molecular genetic testing with detection of the following polymorphic variants of genes: А1166С-AT2R1; C108T-PON1; Thr83Ala- and T138C-MGP; 4b/4a- and G894T-eNOS; as well as I/D-ACE. On completion of our study we established differential prognostic models for prediction of preeclampsia severity in women with pre-existing type 1 diabetes mellitus based on clinical parameters, as well as data about the prevalence of polymorphic variants of genes. The following risk factors were found to be the main contributors to moderate/severe preeclampsia development: presence of vascular complications (diabetic nephropathy and angiopathy of lower extremities), as well as their combinations (nephropathy + retinopathy; nephropathy + angiopathy of lower extremities) at the time of conception; in the presence of diabetic complications – BMI value <23.7 kg/m2; and ACE DD-genotype. In heterozygous carriers of PON1 108CT genotype clinical parameters provide modifying effect: when this genotype is combined with diabetic nephropathy, or duration of diabetes less than 8.5 years, or BMI value less than 23.8 kg/m2 mild preeclampsia develops; in the presence of the same genotype moderate/severe preeclampsia develops when duration of diabetes is over 13.5 years and the value of BMI is over 25.17 kg/m2. Combination of ACE_II/PON1_CC genotypes provides protective effect on preeclampsia development, while ACE_ID/PON1_CT combination is associated with development of mild preeclampsia. Genetic markers defined in our study were found to be helpful in prediction of preeclampsia severity in type 1 diabetic pregnant women. Identification of women at high risk for severe preeclampsia development will let us to implement corresponding preventive measures and to provide closer monitoring, resulting in better pregnancy outcomes.

Key words: pregnancy, type 1 diabetes mellitus, preeclampsia; prediction, genetic markers, gene polymorphism. 

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