University Hospitals of Leicester, UK.
Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, UK.
Diabetes Res Clin Pract. 2018 May;139:170-178. doi: 10.1016/j.diabres.2018.03.003. Epub 2018 Mar 7.
Gestational diabetes mellitus (GDM) is a major clinical challenge and is likely to remain so as the incidence of GDM continues to increase.
To assess longitudinal changes in maternal haemodynamics amongst women diagnosed with GDM requiring either metformin or dietary intervention in comparison to low-risk healthy controls.
Fifty-six pregnant women attending their first appointment at the GDM clinic and 60 low-risk healthy pregnant controls attending their routine antenatal clinics were recruited and assigned to three groups: GDM Metformin (GDM-M), GDM Diet (GDM-D) and Control. Non-invasive assessment of maternal haemodynamics, using recognised measures of arterial stiffness and central blood pressure (Arteriograph®), were undertaken under controlled conditions within four gestational windows: antenatal; AN1 (26-28 weeks), AN2 (32-34 weeks) and AN3 (37-40 weeks), and postnatal (PN) (6-8 weeks after delivery). Data were analysed using a linear mixed model incorporating gestational age and other relevant predictors, including age, blood pressure (BP), baseline bodyweight and pulse as fixed effects, and patient as a random effect.
Fitted linear mixed models showed evidence of a two-way interaction effect between groups (GDM-D, GDM-M and Control) and stages of gestation (AN1, AN2, AN3 and PN) for maternal haemodynamic parameters: brachial artery augmentation index (AIx) (p = 0.004), aortic AIx (p = 0.008), and central systolic BP (p = 0.001). However, differences in respect of aortic pulse wave velocity (p = 0.001) and heart rate (p < 0.001) were only significant for gestational stage. At AN2, we did not observe any evidence that the mean brachial Aix in the GDM-M was different from the control group (p = 0.158).
AIx and central systolic BP measures of arterial stiffness are adversely affected by GDM in comparison to controls during pregnancy. The possible beneficial effects of metformin therapy seen at 32 to 34 weeks of gestation require further exploration.
妊娠糖尿病（GDM）是一个主要的临床挑战，并且随着 GDM 的发病率持续增加，它可能仍然是一个挑战。
评估在需要二甲双胍或饮食干预的 GDM 妇女与低风险健康对照者中，诊断后母体血液动力学的纵向变化。
招募了 56 名在 GDM 诊所就诊的首次就诊的孕妇和 60 名在常规产前诊所就诊的低风险健康孕妇，并将其分为三组：GDM 二甲双胍（GDM-M）、GDM 饮食（GDM-D）和对照组。在四个妊娠窗口内（产前；AN1（26-28 周）、AN2（32-34 周）和 AN3（37-40 周）和产后（PN）（分娩后 6-8 周），使用公认的动脉僵硬度和中心血压（Arteriograph®）测量方法，在控制条件下对母体血液动力学进行非侵入性评估。使用包含胎龄和其他相关预测因子（年龄、血压（BP）、基线体重和脉搏）的线性混合模型分析数据，作为固定效应，患者作为随机效应。
拟合的线性混合模型显示，母体血液动力学参数（肱动脉增强指数（AIx）、主动脉 AIx 和中心收缩压）在组（GDM-D、GDM-M 和对照组）和妊娠阶段（AN1、AN2、AN3 和 PN）之间存在双向交互作用的证据（p=0.004、p=0.008 和 p=0.001）。然而，主动脉脉搏波速度（p=0.001）和心率（p<0.001）的差异仅与妊娠阶段有关。在 AN2 时，我们没有观察到 GDM-M 组的平均肱动脉 Aix 与对照组有任何差异（p=0.158）。
与对照组相比，妊娠期间 GDM 会使动脉僵硬度的 AIx 和中心收缩压测量值受到不利影响。二甲双胍治疗在 32 至 34 周妊娠时的可能有益效果需要进一步探索。
