Maternal Hemodynamics at 11–13 Weeks’ Gestation in Gestational Diabetes Mellitus

Abstract

Objective: Women who develop gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes and subsequent cardiovascular mortality and morbidity. Individuals with cardiovascular disorders have increased central aortic systolic blood pressure (SBP_Ao) and arterial stiffness. The hypothesis of this study is that increased SBP_Ao and arterial stiffness are apparent before the development of GDM. Methods: In this screening study, SBP_Ao, pulse wave velocity (PWV) and augmentation index (AIx) were measured in women with singleton pregnancies attending for routine antenatal care at 11–13 weeks’ gestation. We compared SBP_Ao, PWV and AIx, expressed as multiples of the median (MoM), after adjustment for maternal characteristics affecting these measurements, in women who subsequently developed GDM (n = 105) with the values in non-GDM controls (n = 6,736). Results: In the GDM group, compared to non-GDM controls, there was an increase in PWV [1.04 MoM, interquartile range (IQR) 0.93–1.15 vs. 1.00 MoM, IQR 0.90–1.12; p = 0.013] and SBP_Ao (1.03 MoM, IQR 0.98–1.14 vs. 1.00 MoM, IQR 0.94–1.08; p < 0.0001) but no significant difference in the AIx (1.02 MoM, IQR 0.89–1.22 vs. 1.00 MoM, IQR 0.87–1.17; p = 0.118). Conclusion: Women who develop GDM have increased SBP_Ao and arterial stiffness from the first trimester of pregnancy before the clinical onset of GDM.