Key result
Prior gestational diabetes linked to ~29-point lower small-artery endothelium-dependent dilation 2 years postpartum.
Why the study?
Gestational diabetes mellitus is associated with later adverse cardiovascular risk, prompting examination of how glycaemia during pregnancy relates to small artery function and structure approximately 2 years postpartum.
Cohort (n=29)
Answers are grounded in this paper and cite their sources.
Gestational glycaemia may relate to postpartum small artery changes; leaves open its value for later cardiovascular risk prediction.
GDM (gestational diabetes mellitus) is associated with later adverse cardiovascular risk. The present study examined the relationship between glycaemia during pregnancy and small artery function and structures approx. 2 years postpartum. Women were originally enrolled in the HAPO (Hyperglycaemia and Adverse Pregnancy Outcome) study from which they were classified by their glycaemic distribution during pregnancy as controls (in the lower half of the distribution), UQ (upper quartile; in the UQ of the glycaemic distribution) or having had overt GDM. Subcutaneous arteries from a gluteal fat biopsy taken at follow-up 2 years later were examined using wire myography. Small artery structure, stiffness and vasoconstrictor responses were similar across groups. Maximal endothelium-dependent dilation in response to carbachol was impaired in arteries from both GDM (43.3%, n=8 and P=0.01) and UQ (51.7%, n=13 and P=0.04) women despite generally 'normal' current glycaemia (controls, 72.7% and n=8). Inhibition of NOS (nitric oxide synthase) significantly reduced maximum endothelium-dependent dilation in controls but had no effect on arteries from UQ and GDM women, suggesting impaired NOS activity in these groups. Endothelium-independent dilation was unaffected in arteries from previous GDM and UQ women when compared with the control group. Multiple regression analysis suggested that BMI (body mass index) at biopsy was the most potent factor independently associated with small artery function, with no effect of current glycaemia. Overweight women with either GDM or marginally raised glycaemia during pregnancy (our UQ group) had normal vascular structure and stiffness, but clearly detectable progressively impaired endothelium-dependent function at 2 years follow-up. These results suggest that vascular pathology, which may still be reversible, is detectable very early in women at risk of decline into Type 2 diabetes mellitus.
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Banerjee et al. (2011) conducted a cohort in Gestational diabetes mellitus and altered glycaemia during pregnancy (n=29). Gestational diabetes mellitus (GDM) or upper quartile (UQ) pregnancy glycaemia vs. Control (lower half of the pregnancy glycaemic distribution) was evaluated on Maximal endothelium-dependent dilation in response to carbachol in subcutaneous small arteries (p=0.01). Prior gestational diabetes and upper-quartile pregnancy glycaemia were associated with impaired small-artery endothelium-dependent dilation 2 years postpartum (43.3% and 51.7% vs 72.7%; P<=0.04).
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