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Anness AR, Foster M, Osman MW, Webb D, Robinson T, Khalil A, Walkinshaw N, Mousa HA. Do maternal haemodynamics have a causal influence on treatment for gestational diabetes? J OBSTET GYNAECOL 2024; 44:2307883. [PMID: 38389317 DOI: 10.1080/01443615.2024.2307883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Arterial stiffening is believed to contribute to the worsening of insulin resistance, and factors which are associated with needing pharmacological treatment of gestational diabetes (GDM), such as maternal obesity or advanced age, are associated with impaired cardiovascular adaptation to pregnancy. In this observational study, we aimed to investigate causal relationships between maternal haemodynamics and treatment requirement amongst women with GDM. METHODS We assessed maternal haemodynamics in women with GDM, comparing those who remained on dietary treatment with those who required pharmacological management. Maternal haemodynamics were assessed using the Arteriograph® (TensioMed Ltd, Budapest, Hungary) and the NICOM® non-invasive bio-reactance method (Cheetah Medical, Portland, Oregon, USA). A graphical causal inference technique was used for statistical analysis. RESULTS 120 women with GDM were included in the analysis. Maternal booking BMI was identified as having a causative influence on treatment requirement, with each unit increase in BMI increasing the odds of needing metformin and/or insulin therapy by 12% [OR 1.12 (1.02 - 1.22)]. The raw values of maternal heart rate (87.6 ± 11.7 vs. 92.9 ± 11.90 bpm, p = 0.014) and PWV (7.8 ± 1.04 vs. 8.4 ± 1.61 m/s, p = 0.029) were both significantly higher amongst the women requiring pharmacological management, though these relationships did not remain significant in causal logistic regression. CONCLUSIONS Maternal BMI at booking has a causal, rather than simply associational, relationship on the need for pharmacological treatment of GDM. No significant causal relationships were found between maternal haemodynamics and the need for pharmacological treatment.
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Affiliation(s)
- Abigail R Anness
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Michael Foster
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Mohammed W Osman
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - David Webb
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Asma Khalil
- Fetal Medicine Unit, St. George's University Hospital (University of London), UK
| | - Neil Walkinshaw
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Hatem A Mousa
- Maternal and Fetal Medicine Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
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Sonaglioni A, Bordoni T, Naselli A, Nicolosi GL, Grasso E, Bianchi S, Ferrulli A, Lombardo M, Ambrosio G. Influence of gestational diabetes mellitus on subclinical myocardial dysfunction during pregnancy: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2024; 292:17-24. [PMID: 37951113 DOI: 10.1016/j.ejogrb.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/11/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
OBJECTIVE The correlation between gestational diabetes mellitus (GDM) and subclinical myocardial dysfunction has been poorly investigated. Accordingly, we performed a meta-analysis to examine the influence of GDM on left ventricular (LV) global longitudinal strain (GLS), assessed by speckle tracking echocardiography (STE), during pregnancy. STUDY DESIGN All echocardiographic studies assessing conventional echoDoppler parameters and LV-GLS in GDM women vs. healthy controls, selected from PubMed and EMBASE databases, were included. The risk of bias was assessed by using the National Institutes of Health (NIH) Quality Assessment of Case-Control Studies. The subtotal and overall standardized mean differences (SMDs) of LV-GLS were calculated using the random-effect model. RESULTS The full-texts of 10 studies with 1147 women with GDM and 7706 pregnant women without diabetes were analyzed. GDM women enrolled in the included studies were diagnosed with a small reduction in LV-GLS in comparison to controls (average value -19.4 ± 2.5 vs -21.8 ± 2.5 %, P < 0.001) and to the accepted reference values (more negative than -20 %). Substantial heterogeneity was detected for the included studies, with an overall statistic value I2 of 94.4 % (P < 0.001). Large SMDs were obtained for the included studies, with an overall SMD of -0.97 (95 %CI -1.32, -0.63, P < 0.001). Egger's test for a regression intercept gave a P-value of 0.99, indicating no publication bias. On meta-regression analysis, all moderators and/or potential confounders (age at pregnancy, BMI, systolic blood pressure and ethnicity) were not significantly associated with effect modification (all P < 0.05). CONCLUSIONS GDM is independently associated with subclinical myocardial dysfunction in pregnancy. STE analysis allows to identify, among GDM women, those who might benefit of targeted non-pharmacological and/or pharmacological interventions, aimed at reducing the risk of developing type 2 diabetes and cardiovascular complications later in life.
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Affiliation(s)
| | - Teresa Bordoni
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | | | | | - Enzo Grasso
- Division of Cardiology, IRCCS MultiMedica, Milan, Italy
| | - Stefano Bianchi
- Division of Gynecology and Obstetrics, IRCCS MultiMedica, Milan, Italy
| | - Anna Ferrulli
- Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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Mansukhani T, Arechvo A, Cecchini F, Breim M, Wright A, Nicolaides KH, Charakida M. Vascular phenotype at 35-37 weeks' gestation in women with gestational diabetes mellitus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:386-391. [PMID: 36173400 DOI: 10.1002/uog.26077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To examine the vascular phenotype at 35-37 weeks' gestation of women with gestational diabetes mellitus (GDM) and compare it to that in women without GDM, using ophthalmic artery Doppler and carotid-femoral pulse-wave velocity. METHODS This was a prospective observational study of women attending for a routine hospital visit at 35 + 0 to 37 + 6 weeks' gestation. This visit included recording of maternal demographic characteristics and medical history, ophthalmic artery Doppler for calculation of the peak systolic velocity (PSV) ratio and assessment of cardiac output, stroke volume, total peripheral resistance, central systolic and diastolic blood pressure, carotid-femoral pulse-wave velocity and augmentation index. All measurements 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 with those in the non-GDM group. RESULTS The study population of 2018 pregnancies contained 218 (10.8%) that developed GDM, including 78 (35.8%) that were treated with diet alone, 81 (37.2%) treated with metformin and 59 (27.1%) treated with insulin with or without metformin. In the GDM group, compared with the non-GDM group, there were significantly higher ophthalmic artery PSV ratio, carotid-femoral pulse-wave velocity and central systolic blood pressure, but there was no significant difference in cardiac output, stroke volume, total peripheral resistance, central diastolic blood pressure or augmentation index. In the GDM group, women treated with metformin or insulin had a higher ophthalmic artery PSV ratio compared with those treated with diet alone. Additionally, compared with the diet group, the metformin group had higher central systolic blood pressure and the insulin group had a higher carotid-femoral pulse-wave velocity. CONCLUSION Women with GDM have evidence of early vascular disease, and this may contribute to their long-term cardiovascular risk. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Mansukhani
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - A Arechvo
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - F Cecchini
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Breim
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
| | - M Charakida
- Harris Birthright Research Centre for Fetal Medicine, King's College London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Kong X, Zhu Q, Dong Y, Li Y, Liu J, Yan Q, Huang M, Niu Y. Analysis of serum fatty acid, amino acid, and organic acid profiles in gestational hypertension and gestational diabetes mellitus via targeted metabolomics. Front Nutr 2022; 9:974902. [PMID: 36091252 PMCID: PMC9458889 DOI: 10.3389/fnut.2022.974902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to characterize metabolite differences and correlations between hypertensive disorders of pregnancy (HP) and gestational diabetes mellitus (GDM) using univariate, multivariate analyses, RF, and pathway analyses in a cross-sectional study. Dietary surveys were collected and targeted metabolomics was applied to measure levels of serum fatty acids, amino acids, and organic acids in 90 pregnant women at 24–28 weeks gestation at the First Affiliated Hospital of Harbin Medical University. Principal components analysis (PCA) and partial least squares-discriminatory analysis (PLS-DA) models were established to distinguish HP, GDM, and healthy, pregnant control individuals. Univariate and multivariate statistical analyses and Random Forest (RF) were used to identify and map co-metabolites to corresponding pathways in the disease states. Finally, risk factors for the disease were assessed by receiver operating characteristics (ROC) analysis. Dietary survey results showed that HP and GDM patients consumed a high-energy diet and the latter also consumed a high-carbohydrate and high-fat diet. Univariate analysis of clinical indices revealed HP and GDM patients had glycolipid disorders, with the former possessing more severe organ dysfunction. Subsequently, co-areas with significant differences identified by basic discriminant analyses and RF revealed lower levels of pyroglutamic acid and higher levels of 2-hydroxybutyric acid and glutamic acid in the GDM group. The number of metabolites increased in the HP group as compared to the healthy pregnant control group, including pyroglutamic acid, γ-aminobutyric acid (GABA), glutamic acid, oleic acid (C18:1), and palmitic acid (C16:0). ROC curves indicated that area under curve (AUC) for pyroglutamic acid in the GDM group was 0.962 (95% CI, 0.920–1.000), and the AUC of joint indicators, including pyroglutamic acid and GABA, in the HP group was 0.972 (95% CI, 0.938–1.000). Collectively, these results show that both GDM and HP patients at mid-gestation possessed dysregulated glucose and lipid metabolism, which may trigger oxidative stress via glutathione metabolism and biosynthesis of unsaturated fatty acids.
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Affiliation(s)
- Xiangju Kong
- Department of Gynaecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiushuang Zhu
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Yuanjie Dong
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Yuqiao Li
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Jinxiao Liu
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Qingna Yan
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
| | - Mingli Huang
- Department of Gynaecology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
- Mingli Huang,
| | - Yucun Niu
- Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University, Harbin, China
- *Correspondence: Yucun Niu,
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