Scripties UMCG - Rijksuniversiteit Groningen
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Maternal hemodynamic and autonomic function alterations in pregnancies complicated by gestational diabetes mellitus and obesity

(2017) Mulder, M.E.

Objective: Gestational Diabetes Mellitus (GDM) could be considered to be an early expression of metabolic syndrome. This study aims to investigate alterations in hemodynamics and autonomic nervous function in pregnancies complicated by GDM compared to uncomplicated pregnancies, in both non-obese and obese women. We hypothesized that pregnancies complicated by GDM would be associated with impaired hemodynamics and increased sympathetic activity, with an additional impairing effect in pregnancies of obese women. Methods: A prospective observational cohort study of 45 GDM and 209 uncomplicated pregnancies comparing maternal hemodynamics and autonomic nervous function measured with the USCOM BP+ and USCOM 1A devices at 12 and 34 weeks’ gestation. Measurements included peripheral and central blood pressure, heart rate, augmentation index, heart rate variability, cardiac output and systemic vascular resistance. Results: In non-obese women, GDM pregnancies did not show altered hemodynamics nor autonomic function in first or third trimester compared to uncomplicated pregnancies. Obese women, did show increased blood pressures at both 12 and 34 weeks’ gestation in both uncomplicated and GDM pregnancies. Remarkably, women who developed GDM had a significantly lower maternal birthweight than women with uncomplicated pregnancies. Conclusion: Our findings suggest that, in non-obese women, GDM with no other pregnancy complications does not influence maternal hemodynamics nor autonomic function compared to uncomplicated pregnancies. However, obese women had higher blood pressure than non-obese women but had normal autonomic function. Our finding of lower maternal birthweight in women with GDM, confirms the developmental origin of health and disease hypothesis.

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