Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland.
Diabet Med. 2010 Sep;27(9):988-94. doi: 10.1111/j.1464-5491.2010.03062.x.
Autonomic nervous system dysfunction is observed in Type 2 diabetes. As gestational diabetes is a potent risk factor of later Type 2 diabetes, we set out to determine whether autonomic nervous system imbalance could already be observed in women with this condition. Because activity of the sympathetic nervous system tends to be relatively stable in the nocturnal hours, we performed the study at night.
We studied 41 women with gestational diabetes, 22 healthy pregnant controls and 14 non-pregnant controls. We assayed plasma noradrenaline at 24.00, 04.00 and 07.00 h and performed an overnight Holter recording for heart rate variability analysis. In addition, we assayed plasma adrenomedullin, a cardiovascular protective hormone.
Compared with non-pregnant controls, plasma noradrenaline levels were increased at 04.00 and 07.00 h in the gestational diabetic (P = 0.003) and pregnant control (P = 0.002) groups, with no difference between them. Heart rate variability, very-low-frequency and low-frequency power were lower in pregnant groups compared to the non-pregnant controls. Heart rate variability remained unchanged between specified sampling times in the gestational diabetic group, in contrast to fluctuation seen in the control groups.
Gestational diabetes, compared with normal pregnancy, seems not to be a state of overall sympathetic nervous system activation. At the heart level, however, an inhibitory effect on autonomic nervous system modulation was seen. Plasma noradrenaline and heart rate variability correlated well, supporting the use of this function in future studies of overall sympathetic activity during pregnancy.
自主神经系统功能障碍在 2 型糖尿病中观察到。由于妊娠糖尿病是 2 型糖尿病的一个强有力的危险因素，我们着手确定这种情况下的女性是否已经可以观察到自主神经系统失衡。由于交感神经系统的活性在夜间往往相对稳定，因此我们在夜间进行了这项研究。
我们研究了 41 名患有妊娠糖尿病的女性、22 名健康孕妇对照者和 14 名非孕妇对照者。我们在 24.00、04.00 和 07.00 小时测定血浆去甲肾上腺素，并进行了一夜的心率变异性分析动态心电图记录。此外，我们还测定了血浆肾上腺髓质素，这是一种心血管保护激素。
与非孕妇对照组相比，妊娠糖尿病组（P=0.003）和孕妇对照组（P=0.002）在 04.00 和 07.00 时的血浆去甲肾上腺素水平升高，两组之间没有差异。与非孕妇对照组相比，孕妇组的心率变异性、极低频和低频功率较低。与对照组相比，妊娠糖尿病组在特定采样时间之间的心率变异性保持不变，而对照组则出现波动。
与正常妊娠相比，妊娠糖尿病似乎不是总体交感神经系统激活的状态。然而，在心脏水平上，观察到对自主神经系统调节的抑制作用。血浆去甲肾上腺素和心率变异性相关性良好，支持在未来的妊娠期间整体交感活性研究中使用这种功能。
