Increased large arterial stiffness and impaired acetylcholine induced skin vasodilatation in women with previous gestational diabetes mellitus

Abstract

Objective Gestational diabetes is associated with increased risk of developing noninsulin-dependent diabetes (NIDDM) later in life. By the time that a diagnosis of NIDDM is established, functional disturbances in the vascular system may be observed. This study was planned to assess macro-and microvascular function in nonpregnant women without signs of diabetes two to four years after a pregnancy complicated with gestational diabetes.Design Cross-sectional study.Setting Vascular research laboratory in the obstetric unit of a university hospital. Participants Seventeen nonpregnant, healthy women with a history of gestational diabetes and 20 nonpregnant control women of similar age without previous diabetes.Methods For quantification of the mechanical properties in large arterial vessels the wall movements of the abdominal aorta and left common carotid artery were recorded with an ultrasonic tracking system. Microvascular perfusion in the skin of the hand and foot was recorded by a laser Doppler technique to assess the vasodilatory response induced by transcutaneous acetylcholine. Results Women in the gestational diabetes group showed evidence of increased wall stiffness in the common carotid artery and a lower maximum incremental velocity of the pulsatile vessel diameter change in both aorta and carotid artery compared with controls. Acetylcholine induced vasodilatation in both hand and foot was lower in women with previous gestational diabetes compared with controls.Conclusion Abnormal vascular function was found in asymptomatic women with a history of gestational diabetes. It is speculated that these abnormalities might be early evidence of vascular complications associated with subsequent NIDDM.

Different role of endothelin ETA and ETB receptors and endothelial modulators in diabetes-induced hyperreactivity of the rabbit carotid artery to endothelin-1

“…This result would indicate that diabetes impairs the modulatory activity of the endothelium, and that this alteration could contribute, at least partially, to the hyperreactivity of the carotid artery to endothelin-1 observed in diabetic animals. Impairment of the modulatory activity of the endothelium on the vascular response to several stimuli has been reported in the aorta (Pagano et al, 1998) and renal (Costa e Forti and Fonteles, 1998) arteries of alloxan-induced diabetic rabbits and carotid arteries and aorta of women with gestational diabetes (Hu et al, 1998).…”

Impaired Endothelial Function and Increased Carotid Stiffness in 9-Year-Old Children With Low Birthweight

“…As confirmed by our study, the carotid artery is normally stiffer than the aorta in children and young adults. 9,27 During aging, however, stiffness increases to a greater extent in the aorta, and from middle age onward, the aorta is stiffer than the carotid artery vessel wall. 27 Rapid vasodilation induced by ACh is a well-established method to evaluate endothelial function.…”

“…The repeatability of the method has been shown to be satisfactory. 9 The heart rate and brachial blood pressure were recorded intermittently with a sphygmomanometer of oscillometric type, and the values are presented as the mean of 3 repeated recordings.…”

“…The anodal current alone does not elicit vascular responses, and the CV was 18% for repeated measurements of maximum perfusion change after ACh stimulation. 9 To study endothelium-independent vasodilation, an exogenous NO donor was applied to the contralateral dorsal hand skin. Nitroglycerin cream (glyceryli nitratis 1% in Essex cream, 0.07 mL) was placed in the drug-delivery chamber in the head of the LD probe and attached to the skin for 30 minutes.…”

Circulating concentrations of asymmetrical dimethyl- L -arginine are increased in women with previous gestational diabetes

“…Endothelial dysfunction is typically found in patients prone to develop arteriosclerosis such as in Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus [14,15] and in women with previous gestational diabetes (GDM) [16,17] who are at risk of developing Type II diabetes. In Type II diabetes, an increase in ADMA has also been described [18], and insulin resistance was recently reported to be related to ADMA in non-diabetic normotensive subjects [19].…”