Objectives Gestational diabetes mellitus (GDM) is associated with premature cardiovascular disease and adverse cardiovascular outcome in the mother. Subclinical cardiac functional changes in the left ventricle have been reported during pregnancy in women with GDM using conventional echocardiography, but results are inconsistent. The aims of the current study were to assess whether GDM is associated with biventricular systolic dysfunction in the mother and whether these cardiac changes can be detected using the novel echocardiographic modalities of strain imaging and three‐dimensional (3D) echocardiography. Methods This was a cross‐sectional study in women with GDM and controls examined at 26–40 weeks of gestation. All women underwent echocardiography, and 3D volumes of the left and right ventricles and left atrium were collected. Ejection fraction and left ventricular mass were measured using 3D echocardiography. Left ventricular mass was indexed to body surface area. Speckle‐tracking echocardiography was used to assess global longitudinal strain of the left and right ventricles and strain of the left atrium. Results The study population included 123 women with GDM and 246 controls. Women with GDM, compared to controls, were older (35.1 ± 5.2 vs 32.4 ± 5.5 years; P < 0.001), had higher body mass index (30.6 (interquartile range (IQR), 26.2–35.2) vs 27.5 (IQR, 24.7–30.7) kg/m2; P < 0.001) and had higher systolic blood pressure (119.9 ± 11.2 vs 116.4 ± 12.0 mmHg; P = 0.007). In all women with GDM, there was good glycemic control. In women with GDM, compared to controls, there was lower global longitudinal strain of the left ventricle (−19.3% (IQR, −21.4 to −17.6%) vs −20.1% (IQR, −22.1 to −18.7%); P = 0.002) and right ventricle (−22.2% (IQR, −26.1 to −19.8%) vs −24.1% (IQR, −27.0 to −21.9%); P < 0.001). There was no significant difference between the groups in ejection fraction, left ventricular mass, diastolic function assessed by left atrial strain, or 3D functional indices. Conclusions Women with GDM, compared to women with uncomplicated pregnancy, have lower left and right ventricular myocardial deformation. Volumetric assessment using 3D echocardiography does not provide additional information about maternal cardiac function. Strain imaging is a sensitive echocardiographic modality to detect early cardiac functional changes in women with GDM. Further studies are needed to assess the pattern of deterioration of cardiac function with advancing age in women with a history of GDM. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
BackgroundEpidemiological studies have established that women with preeclampsia (PE) are at increased long‐term cardiovascular risk. Mild cardiac functional changes have been documented during pregnancy in women with PE, but how these are modified from transition to postpartum period remains poorly defined. The aim of this study is to determine biventricular cardiovascular changes using novel and sensitive 2D and 3D echocardiographic modalities in pregnancy and to track alterations in both risk factors and cardiovascular indices in the postpartum period.MethodsWe examined 59 women with PE at 34 (IQR 31, 37) weeks’ gestation and at 2‐3 days, 3 and 6 months postpartum. During pregnancy, 118 women with normotensive pregnancy were also recruited as controls. Biventricular ejection fraction and left ventricular mass were measured by 3D echocardiography. Biventricular global longitudinal strain and strain of the left atrium were assessed using speckle tracking imaging.ResultsIn women with PE, compared to controls, there was lower left ventricular diastolic function (left atrial reservoir strain 44.1 vs. 49.2%) and increase in left ventricular mass (148 vs. 128 g/m2), but there was no significant difference in right ventricular functional indices. These alterations in cardiac indices were mostly explained by differences in maternal risk factors. In the postpartum period, most cardiac indices improved by 3 months. Multivariable linear mixed model analysis demonstrated that this improvement was mostly attributed to reduction in weight and blood pressure.ConclusionIn women with PE there is postpartum improvement in cardiac functional and structural indices in parallel with improvement in risk factor profile.This article is protected by copyright. All rights reserved.
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