Vascular phenotype at 35–37 weeks' gestation in women with gestational diabetes mellitus

Abstract

Objectives To examine the vascular phenotype at 35–37 weeks' gestation of women with gestational diabetes mellitus (GDM) and compare it to that in women without GDM, using ophthalmic artery Doppler and carotid–femoral pulse‐wave velocity. Methods This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 37 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ophthalmic artery Doppler for calculation of the peak systolic velocity (PSV) ratio and assessment of cardiac output, stroke volume, total peripheral resistance, central systolic and diastolic blood pressure, carotid–femoral pulse‐wave velocity and augmentation index. All measurements were standardized to remove the effects of maternal characteristics and elements from the medical history, and the adjusted values in the GDM group were compared with those in the non‐GDM group. Results The study population of 2018 pregnancies contained 218 (10.8%) that developed GDM, including 78 (35.8%) that were treated with diet alone, 81 (37.2%) treated with metformin and 59 (27.1%) treated with insulin with or without metformin. In the GDM group, compared with the non‐GDM group, there were significantly higher ophthalmic artery PSV ratio, carotid–femoral pulse‐wave velocity and central systolic blood pressure, but there was no significant difference in cardiac output, stroke volume, total peripheral resistance, central diastolic blood pressure or augmentation index. In the GDM group, women treated with metformin or insulin had a higher ophthalmic artery PSV ratio compared with those treated with diet alone. Additionally, compared with the diet group, the metformin group had higher central systolic blood pressure and the insulin group had a higher carotid–femoral pulse‐wave velocity. Conclusion Women with GDM have evidence of early vascular disease, and this may contribute to their long‐term cardiovascular risk. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Does treatment modality affect measures of arterial stiffness in women with gestational diabetes?

“…Our finding of increased AIx among women with GDM is in agreement with a number of previous studies 7,10 but is at odds with others 6,8,9 . This contrast in findings may be explained by differences in study design.…”

“…The three studies whose findings are at odds with those of our study examined AS at a single timepoint in the third trimester and two of them 6,9 included fewer than 35 women with GDM. Mansukhani et al 8 . included a larger number of women but examined AIx at 35–37 weeks, which straddles two gestational‐age windows of our study, including the ≥ 36 + 0‐week window, at which we also found no significant difference between women with GDM and healthy controls.…”

“…found PWV to be 3.7% higher among women with GDM at 35–37 weeks' gestation. Similarly, three studies found no difference in third‐trimester augmentation index (AIx) between women with GDM and healthy controls 6,8,9 , whereas Savvidou et al 7 . and Kintiraki et al 10 .…”

“…A limitation of these studies is that they evaluated AIx at a single timepoint only, rather than throughout the third trimester. Additionally, with the exception of the study of Mansukhani et al 8 , the studies involved fewer than 50 women in each group and evaluated pregnant women with GDM as a single group without considering the potential impact of different treatment modalities on maternal cardiovascular adaptation.…”

“…Only a handful of studies have investigated changes in central hemodynamics in pregnancies complicated by GDM and they produced conflicting results. Three studies [5][6][7] reported no difference in pulse-wave velocity (PWV) between women with GDM and low-risk controls in the third trimester, whereas Mansukhani et al 8 found PWV to be 3.7% higher among women with GDM at 35-37 weeks' gestation. Similarly, three studies found no difference in third-trimester augmentation index (AIx) between women with GDM and healthy controls 6,8,9 , whereas Savvidou et al 7 and Kintiraki et al 10 both reported increased AIx among women with GDM compared with controls (13.1 ± 8.9% vs 0.7 ± 11.4% (P < 0.001) and 3.77 ± 2.22% vs 1.51 ± 3.35% (P = 0.021), respectively).…”