Department of Internal Medicine, Giannitsa General Hospital, Giannitsa, Greece.
3rd Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Greece.
Hormones (Athens). 2021 Dec;20(4):753-760. doi: 10.1007/s42000-021-00311-4. Epub 2021 Jul 26.
Gestational diabetes mellitus (GDM) is associated with an increased risk for maternal and fetal complications. Patients with GDM have an increased cardiovascular risk in later life. The aim of this study was to investigate cardiac autonomic nervous system (ANS) function at rest and during exercise in women with GDM vs. women with uncomplicated pregnancies.
Thirty-six normotensive pregnant women (21 with GDM and 15 age- and parity-matched women with an uncomplicated pregnancy) were enrolled in this case-control study. Continuous beat-by-beat blood pressure (BP) measurements were recorded during rest, intermittent handgrip exercise, and recovery (via photoplethysmography, Finapres®). Heart rate variability (HRV) (Kubios®) was used for the assessment of autonomic nervous system function.
The groups were similar in age, gestational week, and handgrip strength. At rest, no differences in HRV indices [root mean square of successive differences (RMSSD), standard deviation Poincaré plot 1, and 2 (SD1, SD2), SD2/SD1 ratio] were detected between women with GDM and women with an uncomplicated pregnancy. However, during exercise, a different pattern in the HRV responses was detected: in the control group, RMSSD and SD1 (indices of parasympathetic function) significantly decreased (p < 0.001) during handgrip exercise and returned to baseline during recovery. In contrast, in GDM, the above HRV indices remained unaltered throughout the protocol.
Normotensive women with GDM present impaired parasympathetic system ability to adapt to an exercise stimulus, as suggested by the blunted sensitivity in RMSSD and SD1. This finding suggests early alterations in ANS may exist in women with GDM, even when no differences are detected in resting conditions.
妊娠期糖尿病（GDM）与母婴并发症风险增加相关。GDM 患者在以后的生活中有更高的心血管风险。本研究旨在探讨 GDM 与无并发症妊娠妇女在静息和运动时心脏自主神经系统（ANS）功能的差异。
本病例对照研究纳入了 36 名血压正常的孕妇（21 名 GDM 患者和 15 名年龄和产次匹配的无并发症妊娠妇女）。通过光体积描记法（Finapres®）在静息、间歇性握力运动和恢复期间连续记录每搏血压（BP）测量值。心率变异性（HRV）（Kubios®）用于评估自主神经系统功能。
两组在年龄、妊娠周数和握力方面相似。在静息状态下，GDM 组和无并发症妊娠组的 HRV 指数[均方根差的连续差异（RMSSD）、Poincaré 图 1 标准差（SD1）和 2（SD2）、SD2/SD1 比值]无差异。然而，在运动期间，HRV 反应模式存在差异：在对照组中，RMSSD 和 SD1（副交感神经功能指数）在握力运动期间显著降低（p<0.001），并在恢复期间恢复到基线。相比之下，在 GDM 组中，上述 HRV 指数在整个方案中保持不变。
血压正常的 GDM 妇女在运动刺激下表现出副交感神经系统适应能力受损，这表明 RMSSD 和 SD1 的敏感性降低。这一发现表明，即使在静息状态下没有差异，GDM 妇女的 ANS 可能已经存在早期改变。
