The influence of single nucleotide polymorphisms of Endothelial Nitric Oxide Synthase and Angiotensin-Converting Enzyme on the course of pregnancy complicated by type 1 diabetes

Aim: to study the frequency of genetic variants of eNOS and ACE polimorphism and their possible influence on the course of diabetic pregnancy and perinatal outcome. Material and methods: 107 pregnant women with type 1 diabetes, treated at the Department of Obstetrics and Women’s Diseases between 2008-2011, were enrolled into the study. Ninety six (90%) of the patients delivered at term. All women were treated with intensive insulin therapy. Glucose control was performed by means of self-monitoring with glucometers. The target fasting glucose levels were below 90 mg/dl (5.0 mmol/l) and postprandial below 120 mg/dl (6.7 mmol/l). DNA for the analysis of polimorphisms was extracted from the leukocytes. Afterwards, the number of specific eNOS and ACE genotypes was calculated and the subgroups of alleles of these two genes were created. Results: Subjects with heterozygote genotype eNOS GT and ACE ID constituted the largest group of patients (24/22%); the smallest group presented eNOS TT (ACE II, ID, DD) genotype (8/8% of the whole studied group). Next, selected genotypes were analyzed in relation to the metabolic status, duration of diabetes and perinatal outcome. Results: Our results enabled us to conclude that, despite identical treatment of all gravidas, diabetic patients with eNOS TT polimorphism presented with the highest body weight, and the strongest lipid and glucose disturbances, what probably resulted in marosomic neonatal weight. Conclusions: The eNOS and ACE genetic variants may affect the course of a diabetic pregnancy in terms of metabolic control and perinatal outcome.