Vascular effects of gestational diabetes can be recognized by carotid intima-media thickness: a prospective case-control study

Abstract

Gestational diabetes mellitus (GDM) is a systemic disease that has poor maternal and fetal health outcomes. Patients who are diagnosed with GDM are more likely to encounter cardiovascular system diseases during pregnancy and after birth. Carotid intima-media thickness (CIMT) is used as an early indicator of diseases such as coronary artery disease. This study aims to define the effects of hyperglycemia at an early term using CIMT, maternal and fetal doppler flows in patients diagnosed with GDM. The study included 132 pregnant women who had reached the 24th gestational week. (GDM group n=65, Control group n=67) Comparisons were performed between women with similar demographic characteristics who received a 100-gr oral glucose test (OGT) and GDM diagnosis and who did not. The participants’ routine hemograms and biochemical tests were done during OGT. Fetal biometrics, amniotic fluid index, uterine artery doppler flow, and bilateral CIMT measurements were performed during the obstetric examinations. Gravida, para, and live birth rates of the GDM group participants were higher than those of the control group (p=0.003, 0.002, 0.002 respectively). The amniotic fluid index was found to be higher in the GDM group (p<0.001). Fasting glucose values and platelet counts were higher in the GDM group (p=0.031 and p<0.001). Other laboratory data demonstrated no statistically meaningful differences between the groups (p>0.05). When the doppler measurements were compared, umbilical artery pulsatility index values were discovered to be similar between the groups (p=0.509). While the right uterine artery (UtA) pulsatility index was higher in the GDM group (p<0.001), no statistically significant differences were found between the groups in terms of the left UtA pulsatility index (p=0.485). Right and left CIMTs were higher in the GDM group (p=0.001, p<0.001, p<0.001 respectively). While in the GDM group there was a positive correlation between the thrombocyte level and uterine artery resistance (r=0.336, p=0.006; r=0.397, p=0.044 respectively), no similar correlations were found in the control group. This study found that GDM patients had inflammation, increased resistance in uterine artery flow, and increased CIMT. It has been shown, there is a correlation between CIMT and glucose levels and between thrombocytosis and UtA resistance in GDM patients. Uterine artery doppler data and CIMT measurements could be used as an indicator of systemic inflammation and cardiovascular disease in patients with GDM.