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. 2022 Aug;306(2):357-363.
doi: 10.1007/s00404-021-06288-0. Epub 2021 Oct 26.

Maternal hemodynamic changes in gestational diabetes: a prospective case-control study

Federico Mecacci  1   2 , Serena Ottanelli  2 , Silvia Vannuccini  3 , Sara Clemenza  1 , Federica Lisi  1 , Caterina Serena  2 , Marianna Pina Rambaldi  2 , Serena Simeone  2 , Ilaria Pisani  4 , Felice Petraglia #  1 , Herbert Valensise #  4
Affiliations

Maternal hemodynamic changes in gestational diabetes: a prospective case-control study

Federico Mecacci et al. Arch Gynecol Obstet. 2022 Aug.

Abstract

Purpose: The aim of the study is to compare maternal hemodynamic adaptations in gestational diabetes (GDM) versus healthy pregnancies.

Methods: A prospective case-control study was conducted, comparing 69 singleton pregnancies with GDM and 128 controls, recruited between September 2018 and April 2019 in Maternal-Fetal Medicine Unit, Careggi University Hospital, Florence, Italy. Hemodynamic assessment by UltraSonic Cardiac Output Monitor (USCOM) was performed in both groups in four gestational age intervals: 17-20 weeks (only in early GDM cases), 26-30 weeks, 32-35 weeks and 36-39 weeks. We evaluated six hemodynamic parameters comparing GDM cases versus controls: cardiac output (CO), cardiac index (CI), stroke volume (SV), total vascular resistance (TVR), inotropy index (INO) and potential to kinetic energy ratio (PKR).

Results: GDM group had significantly lower values of CO and SV than controls from the early third trimester (26-30 weeks) until term (p < 0.001). CI is significantly lower in GDM women already at the first evaluation (p = 0.002), whereas TVR and PKR were significantly higher in GDM (p < 0.001). GDM women showed also lower INO values than controls in all assessments.

Conclusions: A hemodynamic maternal maladaptation to pregnancy can be detected in GDM women. The effect of hyperglycemia on vascular system or a poor pre-pregnancy cardiovascular (CV) reserve could explain this hemodynamic maladaptation. The abnormal CV response to pregnancy in GDM women may reveal a predisposition to develop CV disease later in life and might help in identifying patients who need a CV follow-up.

Keywords: Cardiac output; Cardiovascular disease; Gestational diabetes; Inotropy index; Maternal hemodynamics; Total vascular resistance.

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