[Alterations of left ventricular systolic and diastolic function in pregnant women with insulin-dependent diabetes mellitus].

BACKGROUND

During pregnancy, major cardiovascular changes occur. The aim of the following study was to investigate the course of hemodynamic parameters under the increased volume load during pregnancy and delivery in women with insulin-dependent diabetes mellitus.

METHODS

We examined 51 pregnant diabetic and 51 healthy pregnant women. The control group consisted of 51 healthy non-pregnant women. In all women, left ventricular mass and fractional shortening were calculated. To evaluate left ventricular diastolic function, mitral inflow and pulmonary venous flow profiles were analyzed.

RESULTS

During pregnancy left ventricular mass increased, fractional shortening decreased and diastolic dysfunction was found. While the healthy pregnant women developed signs of disturbed relaxation during pregnancy, pregnant diabetic women showed signs of a disturbed relaxation already at the beginning of gestation. A total of 29 pregnant diabetic women developed a restrictive filling pattern already at the 24th week of gestation. The remaining 22 diabetics had a comparable restrictive filling pattern only during vaginal delivery. In 10 of the 29 pregnant diabetic women dangerous complications were documented, while there were no complications in the healthy pregnant women and the other 22 diabetic pregnant women.

CONCLUSIONS

In healthy women pregnancy results in a reversible physiologic left ventricular hypertrophy, a disturbed relaxation pattern and a temporary decrease of left ventricular systolic function. In contrast, pregnant diabetic women demonstrated a delayed relaxation at the beginning of pregnancy and developed a restrictive filling pattern. The early development of a restrictive filling pattern may predispose to complications during delivery in pregnant diabetic women.