Maternal cardiac function at 19-23 weeks' gestation in prediction of gestational diabetes mellitus

Autor: Alan Wright, R. Vallenas Campos, E. Gibbone, K. H. Nicolaides, S Anzoategui, Marietta Charakida
Rok vydání: 2020
Předmět:
Cardiac function curve
Adult
medicine.medical_specialty
endocrine system diseases
Systole
Gestational Age
Risk Assessment
Ultrasonography
Prenatal
Ventricular Function
Left
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Pregnancy
Medicine
Humans
Radiology
Nuclear Medicine and imaging
Medical history
False Positive Reactions
030212 general & internal medicine
Prospective Studies
Risk factor
Cardiac Output
Body surface area
Likelihood Functions
030219 obstetrics & reproductive medicine
Ejection fraction
Radiological and Ultrasound Technology
business.industry
Obstetrics
Hemodynamics
nutritional and metabolic diseases
Obstetrics and Gynecology
Heart
Stroke Volume
General Medicine
medicine.disease
female genital diseases and pregnancy complications
Gestational diabetes
Diabetes
Gestational
Reproductive Medicine
ROC Curve
Echocardiography
Pregnancy Trimester
Second
Gestation
Female
business
Zdroj: Ultrasound in obstetricsgynecology : the official journal of the International Society of Ultrasound in Obstetrics and GynecologyREFERENCES. 58(1)
ISSN: 1469-0705
Popis: Objectives To examine differences in maternal cardiovascular indices at 19-23 weeks' gestation between pregnancies that develop gestational diabetes mellitus (GDM) and those without GDM and determine whether such cardiovascular changes are the consequence of maternal demographic characteristics and medical history or the GDM per se. Methods This was a prospective observational study in women attending for a routine hospital visit at 19+1 - 23+3 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history and maternal echocardiography for assessment of E/A, E/e', myocardial performance index, global longitudinal systolic strain, left ventricular ejection fraction, peripheral vascular resistance, left ventricular cardiac output and left ventricular mass indexed for body surface area. The measurements of the maternal cardiac indices 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 to those in the non-GDM group. Likelihood ratios were derived for those indices that were significantly altered in GDM and these were used to modify the prior risk derived from maternal demographic characteristics and medical history. The area under the receiver operating characteristic (ROC) curve (AUC) and detection rate (DR) of GDM, at 10%, 20% and 40% false positive rate (FPR), in screening by a combination of maternal factors with cardiovascular indices were determined. Results The study population of 2,853 pregnancies contained 199 (7.0%) that developed GDM. The main findings of the study were: first, in pregnancies that developed GDM there were significant differences from the non-GDM group in E/A, E/e', myocardial performance index and global longitudinal systolic strain; second, after adjustment for maternal demographic characteristics and medical history known to affect cardiac indices the only cardiovascular indices that were significantly different between the GDM and non-GDM groups were peripheral vascular resistance and myocardial performance index and they were both marginally increased; and third, the performance of screening for GDM by maternal demographic characteristics and medical history was not improved by the addition of cardiovascular indices. Conclusion Women with GDM have subtle functional and hemodynamic cardiac changes prior to the development of GDM. These cardiac changes are mostly related to the adverse risk factor profile of these women. Maternal cardiac assessment at 20 weeks does not offer additional predictive information for GDM development in pregnancy to that calculated based on demographic characteristics and medical history. This article is protected by copyright. All rights reserved.
Databáze: OpenAIRE
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