Maternal arterial stiffness and fetal cardiovascular physiology in diabetic pregnancy

Moodley, Shreya; Arunamata, Alisa; Stauffer, Katie Jo; Nourse, Susan E.; Chen, A.; Quirin, Amy; Tierney, Elif Seda Selamet

doi:10.1002/uog.17528

Cited by 17 publications

(20 citation statements)

References 52 publications

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“…In a prospective study conducted by Moodley et al, it was shown that pregnant women with pregestational and gestational diabetes mellitus had more arterial stiffness compared to non-diabetic pregnant women, but this variability did not cause a deterioration in placental or fetal cardiovascular parameters. [32] In our study, no difference was found between the two groups in terms of arterial stiffness. The reason for not showing a difference between the study and control groups in terms of arterial stiffness may be that the cardiovascular evaluation of the patients with gestational diabetes mellitus was performed as soon as they were diagnosed.…”

Section: Discussioncontrasting

confidence: 60%

Evaluation of epicardial fat tissue thickness and aortic stiffness in patients with gestational diabetes mellitus

Akin¹,

Kasap²,

Akın³

et al. 2021

Perinatal J

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Objective We aimed to assess the relationship between gestational diabetes mellitus and coronary artery disease by measuring epicardial fat tissue thickness and aortic stiffness in pregnant women diagnosed with gestational diabetes mellitus. Methods 28 pregnant women diagnosed with gestational diabetes mellitus and 25 pregnant women without gestational diabetes mellitus were included in the research. Body mass index, laboratory values, blood pressure measurements and obstetric history findings of the study population were recorded. All participants of the study population were evaluated with transthoracic echocardiography between 24 and 28 weeks of gestational period. The measurement of epicardial fat tissue thickness was taken and aortic stiffness index was also calculated. Results The age, gravidity, parity and obstetric history of the two groups were similar. Epicardial fat tissue thickness was found significantly higher in gestational diabetes mellitus group than control group (0.416 cm and 0.336 cm, respectively; p<0.001). However, no significant difference was found in aortic stiffness measurements of the two groups (p=0.079). Conclusion According to the results of our study, epicardial fat tissue thickness was found to be statistically significantly higher in pregnant women with gestational diabetes mellitus compared to the control group. The fact that no difference was detected in other cardiovascular parameters suggests that measurement of epicardial fat tissue thickness in gestational period may be a beneficial adjunctive tool in early detection of gestational diabetes mellitus.

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Section: Discussioncontrasting

confidence: 60%

Evaluation of epicardial fat tissue thickness and aortic stiffness in patients with gestational diabetes mellitus

Akin¹,

Kasap²,

Akın³

et al. 2021

Perinatal J

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show abstract

“…To our knowledge, this is the first study looking comprehensively at biventricular function and utilizing speckle-tracking assessment. Obesity in pregnancy is a strong risk factor for the development of hypertensive disorders of pregnancy, fetal growth restriction and gestational diabetes, all of which have been shown to be associated with significant deficits in maternal cardiovascular function [28][29][30][31][32][33] . By excluding from our prospective study obese women who developed these complications, we may have inadvertently introduced exclusion bias by not studying obese women who developed cardiac dysfunction as a consequence of these pregnancy complications.…”

Section: Discussionmentioning

confidence: 99%

Cardiac maladaptation in obese pregnant women at term

Buddeberg

Sharma

O’Driscoll

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Obesity is an increasing problem worldwide, with well recognized detrimental effects on cardiovascular health; however, very little is known about the effect of obesity on cardiovascular adaptation to pregnancy. The aim of the present study was to compare biventricular cardiac function at term between obese pregnant women and pregnant women with normal body weight, utilizing conventional echocardiography and speckle-tracking assessment. Methods This was a prospective case-control study of 40 obese, but otherwise healthy, pregnant women with a body mass index (BMI) of ≥ 35 kg/m 2 and 40 healthy pregnant women with a BMI of ≤ 30 kg/m 2. All women underwent a comprehensive echocardiographic examination and speckle-tracking assessment at term. Results Obese pregnant women, compared with controls, had significantly higher systolic blood pressure (117 vs 109 mmHg; P = 0.002), cardiac output (6.73 vs 4.90 L/min; P < 0.001), left ventricular (LV) mass index (74 vs 64 g/m 2 ; P < 0.001) and relative wall thickness (0.43 vs 0.37; P < 0.001). Diastolic dysfunction was present in five (12.5%) controls and 16 (40%) obese women (P = 0.004). In obese women, compared with controls, LV global longitudinal strain (-15.59 vs-17.61%; P < 0.001), LV endocardial (-17.30 vs-19.84%; P < 0.001) and epicardial (-13.10 vs-15.73%; P < 0.001) global longitudinal strain as well as LV early diastolic strain rate (1.05 vs 1.24 /s; P = 0.006) were all significantly reduced. No differences were observed in the degree of LV twist and torsion between the two groups. Conclusions Morbidly obese, but otherwise healthy, pregnant women at term had significant LV hypertrophy with evidence of diastolic dysfunction and impaired

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“… 43 Moodley et al. 44 interestingly noted that maternal arterial stiffness is increased in pregestational and gestational diabetic mothers and although this did not correlate with the altered fetal cardiovascular assessments, the authors hypothesized that these findings might show a shared response to the metabolic changes in diabetes. Our cohorts were similar in that the mothers had relatively tight glucose control for diabetes patients and their cohort did not include large for gestational age babies or have obvious evidence of placental insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Persistent Aortic Stiffness and Left Ventricular Hypertrophy in Children of Diabetic Mothers

Eckersley

Lin

et al. 2021

CJC Open

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Background Fetuses of diabetic mothers develop left ventricular (LV) hypertrophy and are at increased long-term risk of cardiovascular disease. In our previous longitudinal study from midgestation to late infancy we showed persistence of LV hypertrophy and increased aortic stiffness compared with infants of healthy mothers, the latter of which correlated with third trimester maternal hemoglobin A1c. In the present study, we reexamined the same cohort in early childhood to determine if these cardiovascular abnormalities persisted. Methods Height, weight, and right arm blood pressure were recorded. A full functional and structural echocardiogram was performed with offline analysis of LV posterior wall and interventricular septal diastolic thickness (IVSd), systolic and diastolic function, and aortic pulse wave velocity. Vascular reactivity was assessed using digital thermal monitoring. Participants also completed a physical activity questionnaire. Results Twenty-five children of diabetic mothers (CDMs) and 20 children from healthy pregnancies (mean age, 5.6 ± 1.7 and 5.3 ± 1.3 years, respectively; P = not significant) were assessed. Compared with controls, IVSd z score was increased in CDMs (1.2 ± 0.6 vs 0.5 ± 0.3, respectively; P = 0.006), with one-fifth having a z score of more than +2.0. Aortic pulse wave velocity was increased in CDMs (3.2 ± 0.6 m/s vs 2.2 ± 0.4 m/s; P = 0.001), and correlated with IVSd z score ( R 2 = 0.81; P = 0.001) and third trimester maternal A1c ( R 2 = 0.65; P < 0.0001). Body surface area, height, weight, blood pressure, vascular reactivity, and physical activity scores did not differ between groups. Our longitudinal analysis showed that individuals with greater IVSd, and aortic stiffness in utero, early and late infancy also tended to have greater measures in early childhood ( P < 0.001 and P < 0.0001, respectively). Conclusions CDMs show persistently increased interventricular septal thickness and aortic stiffness in early childhood.

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Maternal arterial stiffness and fetal cardiovascular physiology in diabetic pregnancy

Cited by 17 publications

References 52 publications

Evaluation of epicardial fat tissue thickness and aortic stiffness in patients with gestational diabetes mellitus

Evaluation of epicardial fat tissue thickness and aortic stiffness in patients with gestational diabetes mellitus

Cardiac maladaptation in obese pregnant women at term

Persistent Aortic Stiffness and Left Ventricular Hypertrophy in Children of Diabetic Mothers

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