Need for insulin to control gestational diabetes is reflected in the ambulatory arterial stiffness index

Abstract

BackgroundThe aim was to evaluate the metabolic profile in conjunction with vascular function using the ambulatory arterial stiffness index (AASI) in women with uncomplicated pregnancies and in women with gestational diabetes mellitus (GDM).MethodsPlasma glucose, lipids, HOMA –IR (homeostasis model assessment of insulin resistance) and AASI, as obtained from 24-hour ambulatory blood pressure monitoring in third trimester pregnancy and at three months postpartum, were measured in three groups of women: controls (N = 32), women with GDM on diet (N = 42) and women with GDM requiring insulin treatment (N = 10).ResultsWomen with GDM had poorer glycemic control and higher HOMA-IR during and after pregnancy and their total and LDL (low density lipoprotein) cholesterol levels were significantly higher after pregnancy than in the controls. After delivery, there was an improvement in AASI from 0.26 ± 0.10 to 0.17 ± 0.09 (P = 0.002) in women with GDM on diet, but not in women with GDM receiving insulin whose AASI tended to worsen after delivery from 0.30 ± 0.23 to 0.33 ± 0.09 (NS), then being significantly higher than in the other groups (P = 0.001-0.047).ConclusionsWomen with GDM had more unfavorable lipid profile and higher blood glucose values at three months after delivery, the metabolic profile being worst in women requiring insulin. Interestingly, the metabolic disturbances at three months postpartum were accompanied by a tendency towards arterial stiffness to increase in women requiring insulin.

Insulin therapy and fetoplacental vascular function in gestational diabetes mellitus

“…However, the use of insulin in women with GDM has disadvantages, including the lack of a clear definition of the dose, the need for multiple daily injections and the risk of hypoglycaemia and maternal weight gain (Norman et al 2004). In addition, some women administered insulin for GDM exhibit metabolic alterations at 3 months postpartum, a phenomenon associated with maternal arterial stiffness (Kärkkäinen et al 2013). Other studies also indicate that insulin therapy during GDM is associated with an increased risk for developing type 1 diabetes mellitus (Löbner et al 2006).…”

“…In addition, some women administered insulin for GDM exhibit metabolic alterations at 3 months postpartum, a phenomenon associated with maternal arterial stiffness (Kärkkäinen et al . ). Other studies also indicate that insulin therapy during GDM is associated with an increased risk for developing type 1 diabetes mellitus (Löbner et al .…”

Effect of Human Gestational Diabetes Mellitus on Arterial Stiffness

“…However, no statistically significant difference was found in arterial stiffness between these groups. Karkkainen et al (39) showed that there was a similar increase in arterial stiffness in both the groups, but it was reversible in the non-insulin requiring GDM group and normalized in the postpartum period, whereas it was not in the insulin-requiring GDM group. However, the number of GDM patients, requiring insulin, was very low (n=6).…”

Ambulatory arterial stiffness index and nocturnal blood pressure dipping in pregnancies complicated by hypertension

“…The ambulatory arterial stiffness index (AASI) has been shown to correlate with other techniques of measuring arterial stiffness such as pulse wave velocity and augmentation index, and it has been claimed to be capable of detecting arterial dysfunction at a younger age than is possible with pulse pressure . (Karkkainen et al, 2011(Karkkainen et al, , 2013. (Leoncini et al, 2006;Mule et al, 2008).…”

“…We have previously examined AASI in uncomplicated singleton and twin pregnancies and in pregnancies complicated by gestational diabetes mellitus. (Karkkainen et al, 2011(Karkkainen et al, , 2013.…”