VOLUME 8 NUMBER 3 • SEPTEMBER 2011
109
SA JOURNAL OF DIABETES & VASCULAR DISEASE
ACHIEVING BEST PRACTICE
Assessment of mean platelet volume of pregnant women
wıth gestational diabetes mellitus and impaired glucose
tolerance as a marker of future cardiovascular disease risk
AyDIn KÖS¸ üS¸ , nerMIn KÖS¸ üS¸ , MÜzeyyen DUrAn, nIlGÜn ÖzTÜrK TUrHAn
Abstract
O
bjective
: To assess the platelet count andmean platelet
volume (MPV) of pregnant women with gestational
diabetes mellitus (GDM) or gestational impaired
glucose tolerance (GIGT) to find out whether GDM and GIGT
are risk factors for future development of cardiovascular
disease.
Studydesign:
A50-goral glucose load (OGL)was administered
to all participants and haemotological parameters were
studied at 24–28 gestational weeks. When plasma glucose ≥
140 mg/dl (7.8 mmol/l) was measured following the OGL, a
100-g–3-h oral glucose tolerance test was undertaken.
Results:
A significant difference was observed for MPV values
between the GDM and normal OGL groups.
Conclusion:
Presenceof ahighMPV inGDMcoulddemonstrate
an increase in the risk for current and future thrombotic
complications.
Keywords:
cardiovascular disease risk, gestational diabetes, glucose
intolerance, mean platelet volume
Introduction
GDM is defined as any degree of glucose intolerance with onset
or first recognition during pregnancy.
1,2
GDM affects 1.2–14.3%
of the pregnant population.
1,2
GIGT is also a glycaemic disorder
and is considered as a pre-diabetic state.
3
Considering the GDM
consequences of increased perinatal and maternal morbidity and
mortality, in addition to long-term complications, its accurate
identification and treatment is of utmost importance.
4-6
More than
50% of GDM women will develop type 2 diabetes mellitus in their
future life and women with a history of GIGT also have an increased
risk of developing diabetes.
7
Diabetes is an established risk factor for CVD; therefore, the
subset of women with GDM who develop type 2 diabetes mellitus
are at an increased risk of developing CVD in the future.
8,9
Altered platelet morphology and function have been reported
in patients with the metabolic syndrome, stroke and diabetes
mellitus.
10-14
MPV is a new and independent risk factor for
atherothrombosis and CVD. Many studies have shown that
increased MPV is one of the risk factors for MI, cerebral ischaemia
and transient ischaemic attacks.
10-15
MPV is an important, simple, effortless and cost-effective
measure that should be used for predicting the possibility of
impending acute events like MI and cerebrovascular events.
3,14-16
Patients with larger platelets can easily be identified during routine
haematological examination and could possibly benefit from
preventive treatment.
17
In this study we aimed to assess the platelet count and MPV
values of pregnant women with GDM or GIGT to find out whether
GDM and GIGT are risk factors for future development of CVD.
Materials and methods
The study was conducted at Fatih University, Department of
Obstetrics andGynecology, betweenSeptember 2008andDecember
2009. Cases diagnosed with anaemia, haemoglobinopathy, chronic
inflammatory disease, renal failure, cyanotic congenital heart
diseases, pre-existing diabetes mellitus, other chronic diseases and
pre-eclampsia were excluded from the study. Informed consent was
obtained from all selected subjects.
A 50-g OGl was administered at 24–28 gestational weeks to
all participants. When plasma glucose ≥ 140 mg/dl (7.8 mmol/l)
was measured following the OGl, a 100-g–3-h OGTT was done.
A fasting peripheral venous blood sample was obtained from all
participants at the same time during OGTT. GDM was a plasma
glucose level of ≥ 200 mg/dl (11.1 mmol/l) 1 h after a 50-g OGl
or ≥ two abnormal plasma glucose values in a 3-h 100-g OGTT
according to nDDG criteria (≥ 105 mg/dl [5.8 mmol/l] fasting, ≥ 190
mg/dl [10.6 mmol/l] at 1 h, ≥ 165 mg/dl [9.2 mmol/l] at 2 hours, or
≥ 145 mg/dl [8.1 mmol/l] at 3 h).
18
Only one value abnormality in
100-g OGTT was accepted as GIGT.
Correspondence to: Dr Nermin Kös¸ üs¸
Department of Obstetrics and Gynaecology, Faculty of Medicine, Fatih
University, Ankara, Turkey.
Tel: +90 505 632 50 23
Fax: +90 312 221 32 76 or +90 312 409 88 86
e-mail:
From:
Br J Diabetes Vase Dis
2010;
10
: 233–237
S Afr J Diabetes Vasc Dis
2011;
8
: 109–112.
Abbreviations and acronyms
CVD
cardiovascular disease
EDTA
ethylenediaminetetraacetic acid
GDM
gestational diabetes mellitus
GIGT
gestational impaired glucose tolerance
HSD
honestly significant difference
MI
myocardial infarction
MPV
mean platelet volume
NDDG
National Diabetes Data Group
OGL
oral glucose load
OGTT
oral glucose tolerance test
PDW platelet distribution width
RBC
red blood cell
RDW red cell distribution width
