Study of endothelial function in pregnant women with gestational diabetes mellitus by flow mediated dilation of brachial artery

Abstract

Background: The objective of the study was to assess vascular function in normal pregnant women and women with gestational diabetes and to study its temporal relationship with gestational age at 24-28-week POG and at 36-38-week POG and changes in FMD in postpartum period.Methods: Assessment of vascular function was done at 24-28-week POG, 36-38-week POG and at 6-12-week postpartum by flow mediated dilation of brachial artery in 37 healthy pregnant women and 37 pregnant women with GDM.Results: In GDM group mean FMD at 24-28 weeks of POG, at 36-38 weeks POG was lower as compared to the control group (11.225±6.20,8.464±6.09 versus 14.49±5.21, 10.898±4.12) although the difference in mean FMD in two groups was not statistically significant. It was found that the decrease in FMD at 36-38-week POG as compared to 24-28 weeks POG was statistically significant in both the groups (p<0.001).Conclusions: This study revealed that when endothelial function as assessed by FMD was compared at different period of gestation, the mean decrease in FMD at 36-38-week POG as compared to 24-28-week POG and 6-week post-partum was statistically significant in patients with GDM and as well as the control group, however this trend of change was same in both the groups and was not statistically significant when compared between the two group (GDM versus control). A negative correlation of FMD was found with BMI, and HBA1c, that was stronger in GDM group.

Decreased flow‐mediated dilation in gestational diabetes in pregnancy and post‐partum. A systematic review and meta‐analysis

“…The electronic search from the databases yielded 10,626 potential studies of which 10,609 were excluded as they were duplicates or a review of the title or abstract that did not meet the inclusion criteria, leaving 17 studies for full-text review. After the full manuscript review, five studies were excluded (Table S1) and finally 12 studies were included [21][22][23][24][25][26][27][28][29][30][31][32] (N = 740 pregnant women) (Figure 1). The characteristics of the included studies are shown in Table 1.…”

“…Furthermore, the limited number of studies did not allow us to perform meta‐regression in order to assess the potential effects of maternal BMI, maternal age, and blood pressure, nor a statistical assessment of the publication bias. However, we had extensively searched sources of grey literature and we have indeed identified and included two studies from those sources 23,28 . An additional limitation of the study is the different criteria used for the diagnosis of GDM.…”

“…Data from seven studies [22][23][24]28,29,31,32 (N = 526) were used in the evaluation of FMD% in pregnancy, revealing a significant difference (pooled mean difference −3.12; 95% CI −5.36 to −0.88, I 2 = 96%, p < 0.01) (Figure 2). Data from five 21,[25][26][27]30 (N = 246) were used in the evaluation of FMD% in the post-partum period, revealing a significant difference (pooled mean difference −5.93; 95% CI −9.07 to −2.80, I 2 = 94%, p < 0.01) (Figure 3).…”

“…In the sensitivity analysis, data from six studies 23,24,28,29,31,32 (N = 498) were used in the evaluation of FMD% in pregnancy, revealing a significant difference (pooled standardised mean difference −0.42; 95% CI −0.64 to −0.20, I 2 = 39%, p = 0.13) (Figure 4).…”

“…However, we had extensively searched sources of grey literature and we have indeed identified and included two studies from those sources. 23,28 An additional limitation of the study is the different criteria used for the diagnosis of GDM.…”