Maternal hemodynamic changes in gestational diabetes: a prospective case-control study.

Autor: Mecacci F; Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy.; High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy., Ottanelli S; High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy., Vannuccini S; High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. silvia.vannuccini@unifi.it., Clemenza S; Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy., Lisi F; Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy., Serena C; High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy., Rambaldi MP; High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy., Simeone S; High Risk Pregnancy Unit, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy., Pisani I; Department of Surgery, University 'Tor Vergata', Policlinico Casilino, Rome, Italy., Petraglia F; Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Careggi University Hospital, Florence, Italy., Valensise H; Department of Surgery, University 'Tor Vergata', Policlinico Casilino, Rome, Italy.
Jazyk: angličtina
Zdroj: Archives of gynecology and obstetrics [Arch Gynecol Obstet] 2022 Aug; Vol. 306 (2), pp. 357-363. Date of Electronic Publication: 2021 Oct 26.
DOI: 10.1007/s00404-021-06288-0
Abstrakt: Purpose: The aim of the study is to compare maternal hemodynamic adaptations in gestational diabetes (GDM) versus healthy pregnancies.
Methods: A prospective case-control study was conducted, comparing 69 singleton pregnancies with GDM and 128 controls, recruited between September 2018 and April 2019 in Maternal-Fetal Medicine Unit, Careggi University Hospital, Florence, Italy. Hemodynamic assessment by UltraSonic Cardiac Output Monitor (USCOM) was performed in both groups in four gestational age intervals: 17-20 weeks (only in early GDM cases), 26-30 weeks, 32-35 weeks and 36-39 weeks. We evaluated six hemodynamic parameters comparing GDM cases versus controls: cardiac output (CO), cardiac index (CI), stroke volume (SV), total vascular resistance (TVR), inotropy index (INO) and potential to kinetic energy ratio (PKR).
Results: GDM group had significantly lower values of CO and SV than controls from the early third trimester (26-30 weeks) until term (p < 0.001). CI is significantly lower in GDM women already at the first evaluation (p = 0.002), whereas TVR and PKR were significantly higher in GDM (p < 0.001). GDM women showed also lower INO values than controls in all assessments.
Conclusions: A hemodynamic maternal maladaptation to pregnancy can be detected in GDM women. The effect of hyperglycemia on vascular system or a poor pre-pregnancy cardiovascular (CV) reserve could explain this hemodynamic maladaptation. The abnormal CV response to pregnancy in GDM women may reveal a predisposition to develop CV disease later in life and might help in identifying patients who need a CV follow-up.
(© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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