Impact of gestational diabetes on pelvic floor: A prospective cohort study with three‐dimensional ultrasound during two‐time points in pregnancy

Abstract

Aim: To evaluate the pelvic floor (PF) biometry using three-dimensional ultrasound (US) at two-time points of gestational in pregnant women with gestational diabetes mellitus (GDM). Methods: A prospective cohort study conducted at the Perinatal Diabetes Research Center including 44 pregnant women with GDM and 66 pregnant women without GDM at 24 to 28 weeks of gestation. Three-dimensional transperineal US was performed at 24 to 28 and 34 to 38 weeks of gestation in the lithotomy position at rest. The axial plane of the minimal Levator hiatal dimensions was used to determine Levator ani muscle and Hiatal area (HA) biometry at 24 to 28 and 34 to 38 weeks of gestation. Results: Of the 110 pregnant women, 100 (90.9%) completed the follow-up at 34 to 38 weeks of gestation. The evaluation by US showed a negative biometric change between the two-time points, during pregnancy in women with GDM; in the HA (β coefficient: estimative of effect in biometric progression according to GDM diagnosis, using the non-GDM group as reference = −6.76; P = .020), anteroposterior diameter (β = −5.07; P = .019), and Levator ani thickness (β = −12.34; P = .005). Conclusions: Pregnant women with GDM had a significantly lower than expected percentage of changes in biometry of Levator ani thickness and HA from 24 to 28 to 34 to 38 weeks of gestation when compared with the group of pregnant women without GDM. GDM alters the morphology of PF structures assessed by three

Gestational diabetes is associated with alteration on pelvic floor muscle activation pattern during pregnancy and postpartum: Prospective cohort using electromyography assessment

“…Indeed, higher UI prevalence and severity have been associated with hyperglycemic disturbances not only during pregnancy ( 2 , 3 , 37 ) but also on prediabetes and clinical diabetes ( 38 , 39 ). Three-dimensional ultrasonography during rest showed that there is a decrement of the thickness of the levator ani muscle ( 17 ) during pregnancy, which is consistent with previous morphological findings of a myopathic process on musculoskeletal tissue of GDM pregnant women ( 6 , 15 ). However, conclusive evidence to support this relationship has not yet been assessed due to the lack of studies assessing pelvic floor function by direct measures ( 40 – 42 ), particularly on pregnancy until medium and long-term postpartum ( 13 ).…”

“…Experimental studies in moderate diabetic rat models have shown that the periurethral and rectus abdominis muscles present deterioration, such as atrophy, thinning, disorganization, and co-localization of fast and slow fibers ( 7 , 8 , 10 , 14 ). These data are consistent with those observed in rectus abdominis muscle tissues collected from pregnant women with GDM during C-section ( 6 , 15 ), which suggests that GDM is indeed capable of damaging the muscular tissue causing a myopathic process ( 6 , 15 – 17 ). Establishing a rational line by the morphological findings from urethral and rectus abdominis muscle of rats ( 7 , 8 , 10 , 14 ) and rectus abdominis on pregnant women ( 6 , 15 ), the PFM is also potentially impacted by the myopathic process ( 6 ).…”

“…In a study using electromyography (EMG), the amplitude of PFM signals during rest and hold contraction was decreased from the second to the third trimester. When three-dimensional ultrasonography (3D-US) was used, negative biometric changes, such as a low increase in the hiatal area, a decrease in the anteroposterior diameter, and a reduced levator ani muscle thickness, have also been observed between these two time points ( 16 , 17 ).…”

Pelvic floor muscle dysfunction at 3D transperineal ultrasound in maternal exposure to gestational diabetes mellitus: A prospective cohort study during pregnancy

“…Women with GDM have an increased risk of urinary incontinence (UI) within the first decade after delivery when compared to non‐GDM women 2–4 . Furthermore, GDM is linked to a muscle injury that weakens the pelvic floor muscle (PFM) and rectus abdominis muscles (RAM) during pregnancy 5–8 …”

“…[2][3][4] Furthermore, GDM is linked to a muscle injury that weakens the pelvic floor muscle (PFM) and rectus abdominis muscles (RAM) during pregnancy. [5][6][7][8] According to translational research, the PFM and RAM of pregnant diabetic rats demonstrate atrophy, colocalization of fast and slow fibers, an increased collagen type I/III ratio, and a decrease in total glycosaminoglycan. 9 These major findings from the literature review on hyperglycemia in pregnant rats and PFM and/or RAM myopathy prompted us to ponder if this may occur in GDM women.…”