Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Ring Road, Nea Efkarpia, Thessaloniki, Greece.
Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Serres, Greece.
Metabolism. 2018 Jun;83:25-30. doi: 10.1016/j.metabol.2018.01.009. Epub 2018 Feb 2.
AIM/HYPOTHESIS: This cross-sectional, observational, controlled study examined cerebral oxygenation during exercise, an index of cerebrovascular function and cortical activation, in pregnancies complicated by gestational diabetes mellitus (GDM) and unaffected pregnancies. The association of cerebral oxygenation with macrovascular and cardiovascular function indices was also evaluated.
Vascular function and structure [aortic pulse-wave-velocity (PWV), augmentation index (AI), carotid intima-media thickness], as well as 24-hour ambulatory blood pressure (BP) were assessed in women with GDM (n = 21) and uncomplicated pregnancies (n = 16), at 26-32 gestational weeks. Changes in cerebral oxygenation [oxy- (OHb), deoxy- (HHb) and total- (tHb) hemoglobin] were continuously recorded by near-infrared spectroscopy (NIRS) during intermittent handgrip exercise. Beat-by-beat BP and systemic vascular resistance (SVR) were assessed (Finapres).
Women with GDM had higher AI than controls. During exercise, women with GDM maintained a smaller force (p < 0.05), despite similar ratings of perceived exertion. Despite similar increases in BP during exercise, the GDM group exhibited a lower average and total (AUC) increase in cerebral-OHb than controls (p < 0.05). In addition, GDM exhibited a slower rate of cerebral-OHb decay during recovery (p < 0.05). SVR was lower in GDM compared to controls throughout the protocol (p < 0.01). Cerebral oxygenation indices were correlated with PWV and AI (p < 0.05).
This study provided novel evidence for blunted cerebral oxygenation during exercise in women with GDM compared to uncomplicated pregnancies, suggesting a link between reduced cerebrovascular function with exercise intolerance in GDM. Cerebral oxygenation during physical stress was correlated with macrovascular function and cardiovascular risk factors. More studies are needed to examine whether this impaired cerebral oxygenation reflects early cerebrovascular disease.
目的/假设：本横断面观察性对照研究旨在检测妊娠期糖尿病（GDM）和无并发症妊娠孕妇在运动期间的脑氧合情况，脑氧合是脑血管功能和皮质激活的指标。还评估了脑氧合与大血管和心血管功能指标的相关性。
在 26-32 孕周时，评估了 GDM（n=21）和无并发症妊娠（n=16）孕妇的血管功能和结构[主动脉脉搏波速度（PWV）、增强指数（AI）、颈动脉内膜中层厚度]以及 24 小时动态血压（BP）。通过近红外光谱（NIRS）连续记录间歇性握力运动期间脑氧合的变化[氧合（OHb）、脱氧（HHb）和总（tHb）血红蛋白]。通过 Finapres 评估血压和系统血管阻力（SVR）的逐拍变化。
GDM 女性的 AI 高于对照组。在运动期间，尽管感觉用力相似，但 GDM 女性保持的力较小（p<0.05）。尽管运动期间的血压相似，但 GDM 组的脑-OHb平均和总（AUC）增加低于对照组（p<0.05）。此外，GDM 组在恢复期间的脑-OHb下降速度较慢（p<0.05）。整个方案中，GDM 组的 SVR 均低于对照组（p<0.01）。脑氧合指数与 PWV 和 AI 相关（p<0.05）。
与无并发症妊娠相比，本研究为 GDM 女性在运动期间脑氧合减少提供了新的证据，提示在 GDM 中运动耐量降低与脑血管功能下降有关。体力应激期间的脑氧合与大血管功能和心血管危险因素相关。需要进一步研究来检测这种受损的脑氧合是否反映了早期脑血管疾病。
