Gestational Diabetes: A Condition of Early Diastolic Abnormalities in Young Women

Abstract

Gestational diabetes mellitus (GDM) is not merely a temporary condition, but a harbinger of type 2 diabetes mellitus, hypertension, and atherosclerotic disease. We examined the effect of GDM on cardiac diastolic function. Diastolic function was evaluated by serial Doppler echocardiography with pulsed tissue Doppler imaging in 13 patients with GDM and 13 healthy pregnant women (control group) during the third trimester of pregnancy and after 8 weeks postpartum. Diagnostic criteria for GDM were those as recommended by the American Diabetes Association. Exclusion criteria were any disease or condition that could interfere with diastolic function. Measurements at both times in each group were compared by paired t tests and changes of patients with diabetes were compared with those in control patients by unpaired t tests. There were no differences in age, left ventricular mass, or systolic function between groups. The Doppler parameters that showed significant difference between groups were higher atrial contraction wave (A wave) (P = .008) and lower rapid filling wave (E)/A ratio (P = .006) in diabetic group, on both occasions. Tissue Doppler parameters showed a significant decrease in Em (P = .002) and early mitral annulus velocity (Em)/late mitral annulus velocity (Am) (P = .008) in diabetic group on both occasions, and the Am wave remained increased only in the diabetic group at postpartum. Patients with GDM showed a different diastolic function profile, suggesting a mild degree of diastolic abnormality. The persistence of some abnormalities postpartum corroborates our hypothesis of an early cardiovascular involvement in this group, enhancing the need of a close cardiovascular follow-up of these patients.