Abstract
Previous gestational diabetes mellitus (pGDM) indicates future risk for type 2 diabetes (T2DM). Insulin resistance (IR) may precede T2DM in many years and is associated with an increased risk for cardiovascular diseases.AimThis study aims to identify endothelial dysfunction and cardiovascular risk factors in women with pGDM.MethodsThis cross-sectional analysis included 45 non diabetic women, 20 pGDM and 25 controls, at least one year after delivery. Body mass index (BMI), abdominal circumference (AC), blood pressure, serum lipids, liver enzymes, uric acid, nonesterified fatty acids, C-reactive protein and plasma glucose, insulin, fibrinogen and plasminogen activator inhibitor 1 were measured. HOMA IR and β were calculated. Pre and post induced ischemia videocapillaroscopy was performed in hand nailfold to evaluate microvascular morphologic aspect and functional response.ResultsAC and fasting glucose were significantly higher in pGDM (p = 0.01 and p = 0.002 respectively). Women with pGDM and BMI < 25 kg/m2 had significantly higher levels of fasting insulin and HOMA IR than controls (p = 0.008 and 0.05 respectively). Abnormal morphologic findings were more frequent and papillae rectification were 3.3 times more prevalent in pGDM (p = 0.003). Other microvascular parameters did not differ between groups.ConclusionCardiovascular risk factors and a microcirculation abnormality (papillae rectification) were significantly increased in young non-diabetic women with pGDM.
Highlights
Gestational diabetes mellitus (GDM) is a heterogeneous disorder defined as glucose intolerance first recognized during pregnancy [1]
Women with type 2 diabetes mellitus (T2DM), impaired fasting glucose or glucose intolerance according to OMS criteria [25], current pregnancy, menopause, use of vasoactive, antilipemic or antidiabetics drugs, vascular, kidney, liver, dermatological and infectious diseases were excluded from the analysis
No differences were found among eight women in use of oral contraceptives, when studied separately
Summary
Gestational diabetes mellitus (GDM) is a heterogeneous disorder defined as glucose intolerance first recognized during pregnancy [1]. This metabolic abnormality usually resolves immediately post partum, but implies in a higher risk of future type 2 diabetes mellitus (T2DM). In the vast majority of cases, the pathogenesis of GDM resembles that of T2DM. In both conditions, the β cell reserve is unable to counterbalance the insulin resistance. The β cell reserve is unable to counterbalance the insulin resistance During pregnancy, this increased demand is caused by placental hormones. It has been suggested that GDM and T2DM should be taken as one single entity, clinically evident in different lifetime periods [2]
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