Circulating thrombomodulin levels and clinical correlates in pregnant diabetics

The object of this study was to investigate the relationship of thrombomodulin (TM) and glycosylated hemoglobin (HbA₁C) in pregnant diabetics and to determine clinical correlates. We performed a prospective cohort study of 53 patients: 25 women with insulin-dependent diabetes (group 1) and 28 with gestational diabetes (group 2). Group 1 underwent monthly determinations of HbA₁C and TM. Group 2 underwent determination at 36 weeks of gestation. There was a significant difference in HbA₁C between groups 1 and 2 (p = 0.0005), but there was no difference in TM. There was no correlation between TM and HbA₁C. TM levels correlated positively with serum creatinine (r: 0.46, p = 0.002), proteinuria (r= 0.48, p = 0.007), and duration of diabetes (r = 0.41, p = 0.042). TM was significantly higher in diabetics of advanced White Classification (p = 0.008). With good control, TM does not appear to be elevated in a diabetic pregnancy. TM may be a marker of endothelial damage that correlates more with duration of diabetes and renal disease than with HbA₁C, which reflects short-term control.