Maternal Hemodynamics at 11–13 Weeks’ Gestation in Gestational Diabetes Mellitus

Abstract

Objective: Women who develop gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes and subsequent cardiovascular mortality and morbidity. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP_Ao) and arterial stiffness. The hypothesis of this study is that increased SBP_Ao and arterial stiffness are apparent before the development of GDM. Methods: In this screening study, SBP_Ao, pulse wave velocity (PWV) and augmentation index (AIx) were measured in women with singleton pregnancies attending for routine antenatal care at 11–13 weeks’ gestation. We compared SBP_Ao, PWV and AIx, expressed as multiples of the median (MoM), after adjustment for maternal characteristics affecting these measurements, in women who subsequently developed GDM (n = 105) with the values in non-GDM controls (n = 6,736). Results: In the GDM group, compared to non-GDM controls, there was an increase in PWV [1.04 MoM, interquartile range (IQR) 0.93–1.15 vs. 1.00 MoM, IQR 0.90–1.12; p = 0.013] and SBP_Ao (1.03 MoM, IQR 0.98–1.14 vs. 1.00 MoM, IQR 0.94–1.08; p < 0.0001) but no significant difference in the AIx (1.02 MoM, IQR 0.89–1.22 vs. 1.00 MoM, IQR 0.87–1.17; p = 0.118). Conclusion: Women who develop GDM haveincreased SBP_Ao and arterial stiffness from the first trimester of pregnancy before the clinical onset of GDM.

Assessment of arterial function in pregnancy: recommendations of the International Working Group on Maternal Hemodynamics

“…The brachial artery waveform readings allow AIx calculation as: AIx (%) = ((P2 − P1)/PP) × 100, where PP is pulse pressure, and thus provides the brachial artery AIx without applying a transfer function. Similar to the Vicorder, there are no validation studies of the Arteriograph in pregnancy; however, it has been used widely in pregnancy research and validated against aortic AIx obtained by cardiac catheterization in a non‐pregnant cohort.…”

“…Studies of arterial stiffness in complicated pregnancies have focused largely on pre‐eclampsia, intrauterine growth restriction (IUGR), preterm birth and gestational diabetes (GDM), disorders that are associated with a greater risk of a future cardiovascular event in the mother.…”

“…Arterial stiffness indices are higher in women with established GDM and in those with pre‐existing Type‐2, but not Type‐1, diabetes mellitus. Furthermore, women who develop GDM have increased arterial stiffness which is evident from the first trimester of pregnancy, suggesting its potential predictive value. Possible mechanisms to explain these associations include: (1) alterations in the composition of the extracellular matrix and arterial remodeling, due to hyperglycemia, and (2) oxidative stress, both of which lead to arterial stiffening.…”

Effect of sildenafil on maternal hemodynamics in pregnancies complicated by severe early‐onset fetal growth restriction: planned subgroup analysis from a multicenter randomized placebo‐controlled double‐blind trial

“…The Arteriograph has been validated against invasive and non‐invasive methods in non‐pregnant populations. Even though there are no direct validation studies of the Arteriograph in pregnancy, it has been used on a very large scale in pregnancy research. Measurements from the Arteriograph had a highly significant correlation with conventional tonometric and piezo‐electric platforms.…”

Maternal hemodynamics at 11–13 weeks of gestation and preterm birth

“…Several studies reported increased arterial stiffness and SBP Ao in women with clinically established PE and GDM16–19. It has been demonstrated recently that SBP Ao and arterial stiffness measured at 11–13 weeks' gestation are increased in women who later develop PE and GDM20–23.…”