Evaluation of PT and APTT in Umbilical Cord Blood of Gestational Diabetic Mothers

Abstract

Introduction: GDM affects 2–10% of women during their pregnancy. It is important to recognize and monitor GDM closely due to the risk of adverse effects on the mother and the fetus. Newborns of women with a history of GDM or risky gestation are also at increased long-term risk of developing metabolic diseases and macrosomia. Maternal glucose easily crosses the placenta and as a consequence maternal hyperglycemia leads to intrauterine hyperglycemia, which induces fetal hyperinsulinemia and possible modification of growth and future metabolism of the fetus. The association between hyperglycemia and thrombosis is well known, and thrombosis in fetal umbilical cord vessels rate of 1/250 in risky gestations. It was monitored that there was venous thrombosis in 70 % of the Cases determined to have had cord thrombosis, the casual mechanisms and related effects of thrombosis are not well understood. PT and APTT have been reported to be increased during pregnancy, but how this effect has clinical impact on newborn cord blood PT and APTT is still unexplained. This study aimed to assess PT and APTT level in cord blood of newborn in mothers with gestational diabetes mellitus. Materials and Methods: This is a cross sectional descriptive study carried out in Khartoum state in Saad Aboulela University Hospital, Alsaaha Specialized Hospital and Al-Qma Specialized Hospital, in the period from March to June 2018. Thirty samples collected from cord blood of newborn of GDM and thirty matched control group from cord blood of newborn of healthy pregnant were recruited in this study. Citrated Blood sample was collected from each newborn cord blood of normal pregnant women as control for estimation of PT,INR and APTTby using CL-2000 Biobase automated coagulometer, Data was analyzed by SPSS version 20, and expressed as means and tables. Results: The mean of PT was significant increased in cord blood of infant of GDM (19.61±4.47) when compared to the control group (15.42±1.67) (P. value= 0.000).Also the mean of INR was significant increase in newborn cord blood of GDM (1.64±0.45) compared to the control (1.17±0.16) In addition; the mean of APTT is also significantly increased in newborn cord blood of GDM (53.53±3.86) compared to control group (50.83±4.40) P-value 0.014. An insignificant increase in PT of cord blood from GDM pregnant with FBG <100 (mg/dl) (19.21±5.45) to GDM pregnant women with FBG>100 (mg/dl) (19.79±4.11).Also the INR was insignificant increase in cord blood from GDM pregnant with FBG <100 (mg/dl) (1.67±0.40) to GDM pregnant women with FBG>100 (mg/dl) (1.56±0.56). Otherwise an insignificant increase in APTT of cord blood from GDM pregnant with FBG <100 (mg/dl) (54.33±4.42) to GDM pregnant women with FBG>100 (mg/dl) (53.19±3.65).No correlations between PT ,INR and APTT level and duration of diabetes , BMI, history of diabetes, hypertension of women (P. value > 0.05). Furthermore, no association between PT ,INR and APTT level and newborns weight (P> 0.05). Conclusion: The study concluded that PT, INR and APTT could be used as indicator for the risk of thrombotic abnormality of newborn for future management.